HIStalk Interviews Jay Parkinson MD MPH, House Call Doctor

Photo and site: Jay Parkinson, MD, MPH

I didn’t have much trouble tracking down Jay Parkinson. He’s ubiquitous for a guy whose medical practice is just a few weeks old. He’s been interviewed many times, has a blog, and apparently is coming soon to a TV near you, all because of his Medicine 2.0 – which is actually Medicine 1920s – making house calls, charging reasonable cash prices, and being available whenever his patients need him, all in the hip Williamsburg neighborhood of Brooklyn.

He insists that it’s not about the technology, which in his case is the PC tools everybody else uses (Google apps, e-mail, IM, etc.) He doesn’t even use an EMR system any more, having given it up because it didn’t meet his needs. So, the lessons to learn from Jay aren’t about use of cool technology, but more about practicing medicine the way he wants, addressing some of the challenges of the healthcare system along the way.

Tell me about your background and your practice.

I’m a 31-year old male. [laughs] I practice in New York City, mostly in Williamsburg and Brooklyn. I started the practice September 24 after two residencies, the first one in pediatrics at St. Vincent’s Hospital here in the West Village and the second one in preventive medicine at Johns Hopkins in Baltimore. Seems like it’s going pretty well for me.

Most people associate house calls with country doctors carrying little black bags, but you’re in New York City.

I still have my black bag that I carry. Just getting around the city is next to nothing. You take the subway, walk, or take the bus. In the near future, I’ll be buying a scooter so I can scoot around. Hopefully I can keep every house that I visit within a 15-minute travel time.

Describe a typical patient encounter.

It’s great because they submit all their information ahead of time, so I pretty much know what’s going on prior to the meeting. I know what to talk about, what points to hit, what things I can skip over that other physicians would concentrate on and waste time on. They spend 10-15 minutes giving me all their health information via an online form. It’s very streamlined, but I still spend about an hour and a half per visit, talking to them, having them show me their art work. It’s very laid back.

I’m not a very formal person. Everybody that I’ve seen has really enjoyed seeing their doctor rather than being in some sterile, foreign environment that everybody knows and loves as a doctor’s office.

What’s it like making house calls and what do you learn that an office-based doctor wouldn’t?

Somebody has asthma, maybe lives in a dirty warehouse loft, I can pick up the fact that it’s pretty friggin’ dusty or has mice. It just gives you a feeling for who somebody is. You can tell a lot by how they live, more from a mental health perspective. The United States is a pretty clean place so we don’t have a lot of sanitation issues or something, but it gives you a more full picture about the person.

What technology do you use to run your practice?

It’s very basic, freely available technology. I have a Macbook and an iPhone. IM programs, like ATM and iChat for the Mac. I just use regular e-mail, Gmail in fact, because it’s very powerful.

I use a website called Formspring for my online forms. It’s very simply drag and drop forms creation. Any form can be made in three minutes or so. It uses skip branch logic, so questions can appear or disappear based on responses to previous questions. I use that to get another diagnosis through a careful history, because an early question is a branch in the algorithm for proper history taking. I think it’s safer because doctors aren’t perfect and sometimes they forget to ask very important questions about something rare. If I can spend time asking these questions beforehand, I don’t have to be worried about always thinking about every little thing during my interview session with the patient.

I saw on the Web that you use the Life Record medical record system. Tell me how you chose it and how it works for you.

Actually, I have abandoned that, simply because it’s not very customizable and I thought it was going to be. So, I’ve abandoned that. But, I was fascinated by it because it has a lot of features that I think would be very valuable for a traditional office-based practice with multiple practitioners. Having access to records by iPhone on a Friday night at dinner is vital in some circumstances.

Now I use Apple’s version of Excel called Apple Numbers and have created templates for nearly every condition that I have. I can use them for a physical exam or generating an invoice. It’s really just using Apple’s iCal for scheduling synced to Gmail’s calendar. iCal and Gmail and iPhone are all updated at the same time in real time. It’s pretty basic stuff.

You’re an iPhone fan, I hear.

I love the iPhone. I think that’s amazing. Hopefully I will be able to put Apple’s Number files on my iPhone. I think they’re coming out in with developer’s kit for iPhone in February and I’ll be able to use my iPhone a little more intensely. I could only get to my records by iPhone with Life Record. He’s a great guy, the guy that developed it, and I’m sorry it isn’t specific for what I need.

When it comes to technology, you seem to be a geek, but you deal with artists and are one heck of a photographer. Where do you fall on the geek-doctor-artist continuum?

I’m definitely fairly geeky, I guess. I really like technology and gadgets. Right after the iPhone came out, I wasn’t going to wait in line forever down in Baltimore. I’m all things Apple. I did the iPod first day it was announced years ago. I designed my own website and can do programming. I don’t know CSS or anything like that. I’m not trained in any technology, I just kind of figured it out on my own.

You charge $200 a house call. Do patients find that competitive and can you make a decent living at that price?

Sure. Look, I have no overhead whatsoever. If I charge $200 a visit, $195 of that is straight profit. I think that’s a pretty good living. If I see eight patients a day, that’s $1600. Without having staff, an office, billers … it becomes a very easily doable practice. I definitely designed the business model looking at that. The concept of doing the housecall was a way to open a practice without putting $300,000 upfront. I started this whole thing for less than $1,500.

Would your med school classmates think this is weird, or are they looking for more satisfying practice models too?

Everybody that I’ve trained with has been extremely supportive. I just got done with an interview for the London Times. Obviously there’s something interesting about what I’m doing since now I’m making international news.

What I’ve created, not to toot my own horn, is pretty ingenious. It’s a Band-Aid to a gaping wound in a lot of ways, the fiasco that is the American healthcare system. 50 million people without health insurance – there are a lot of voices behind what I’m trying to do. I’m doing a good job, I guess, getting the word out about the plight of the uninsured and also seeing patients at the same time.

A few people have mentioned security and privacy issues because of the technology I use, but because I don’t deal with insurance companies and don’t submit any patient health information online to insurance companies or Medicare or Medicaid, I don’t have to follow HIPAA regulations. I’m considered a country doctor, which is kind of interesting.

On your website, you talk about how you search the market to find the lowest fees for specialists and other medical services you can’t provide directly. How do you do that and what interesting stuff have you found as a result?

It will blow your mind what I found out. I graduated residency June 30th. Since then, between June 30 and September 24, there’s a good three months where that was what I was doing, finding accurate contact info for physicians in New York City and calling them up and asking what they charge, putting the information into a database. A mammogram ranges from $175 to $750, both of them amazing facilities, but nobody’s regulating healthcare prices.

Also, there’s widespread belief in the healthcare industry that they shouldn’t be competing for cash-paying patients because there’s so few of them. 50 million isn’t that few at all, but there’s no free market in the healthcare industry. The vast number of people have health insurance and doctors aren’t competing for their business at all. Its so funny, when I tell radiologists or pharmacists or anyone who stands to benefit from me referring my cash-paying customers to, it’s laughable how they kiss my ass to try to get my business.

The ultimate goal here is to create more transparency in the healthcare pricing scheme. I’m trying to create that transparency on my own because the healthcare industry won’t do it because they profit from that.

How would you compare what you do with the retail clinics that are springing up everywhere?

Most of the time, it’s simply a profit-driven marketing scheme. I’m personalized service. You call me up, I go to your home, physically examine you, follow up by IM or e-mail or text messaging. I get to know you as a person. I’m not remotely competing with retail clinics at all. People who go there want something different than I provide.

From your viewpoint, what’s the most wrong and most right about the US healthcare system?

It depends on who we’re talking about. Older people and very poor people, there’s absolutely nothing wrong with it whatsoever. For people who have insurance, there’s not much wrong. People who don’t have insurance because they’re young and healthy and priced out of paying an average $10,000 here in New York for an HMO, there’s a lot wrong. It really just depends on who you’re talking about. It’s hard to generalize that way.

My patients are people who are concerned about having or not having health insurance. New York State has policies that ensures that everyone pays the same for health insurance. That’s great for sick and old people, but young people can’t justify spending $9,500 when they only make $45,000. That to me is a significant problem for the uninsured in New York State. It’s a great solution if you’re old and sick.

You just started this practice and here you are, four or five weeks later, you’re in newspapers and on TV. You mentioned in an interview that you’re getting unbelievable offers to do TV and books. What’s coming your way?

You name it, I’ve gotten it. It’s pretty insane. Keep your eye out, probably next fall, for a TV series from a producer of movies that the whole world has seen, She’s getting back into an original series. I’m starting to write with her in a week and we’re going to start developing a TV series together, not a reality series. The major networks are interested in this concept. We’re developing it so it appeals to everybody, but it deals with the healthcare issues that are afflicting America. That’s in the works.

I got a book offer on Monday, so I’ll be writing a book about the healthcare industry using examples from my life and practice. The London Times was today. I’ll be doing a big talk show soon and Steven Colbert on November 12. It’s kind of insane. They’re all coming to me. I don’t have a PR person. I’m doing everything myself. I haven’t put out a single press release.

Is is scary that people want you to comment on an industry that you’re brand new to?

No, not at all. Sure, I don’t have experience in private practice dealing with insurance companies, but I’ve worked and talked about the healthcare system for years, getting my master’s in public health. I worked with Sidney Wolfe in Public Citizen’s Health Research, Ralph Nader’s consumer watchdog group in DC. I’ve worked at the Maryland state department of health level. I worked with National Association of Firefighters as their medical consultant. I’ve done a lot.

I’m not like a normal doctor who finished a residency and sees patients. I intensely studied the healthcare system and figured out its strengths and deficiencies. I spent the last three months at Hopkins on quality of patient care, studying quality in the American healthcare system. Doing Six Sigma and Lean Kaizen in various departments in Johns Hopkins, trying to figure out where the patient problems lie, problems with reimbursement and unsafe practices that lead to poor outcomes. I’m not worried about being a spokesperson.

Do you think you’ll keep practicing with all these offers?

I wouldn’t mind doing part-time for both. One thing I don’t want to be is part of the industry. I’ve got plenty of offers to join companies and form alliances, but then you become part of the problem, like most doctors. The practice of medicine is very conservative and appeals to a conservative type of person. They don’t really teach you to think outside the box. They try to prohibit you from thinking outside the box.

A lot of people are getting hung up on the “doctor who makes house calls.” Really, there’s no difference in seeing a patient in their homes instead of in the office. I don’t have a laboratory, so I can’t do rapid strep tests. It’s a little difficult to do male urethral swabs, stuff like that. Female exams, I just don’t do, but I refer to someone.

There’s really no difference between a house call environment and an office environment. I draw blood as I need it and a car comes up and picks it up outside my apartment door each night. To me, it was just a business model to start a practice on the cheap. People are also hung up on the technology, but it’s the stuff that everybody uses in every other industry in America. It’s just not being used to communicate with doctors.

Most doctors don’t even want to get patient e-mails.

Congress just passed a 10% Medicare reduction on to physicians yesterday. The only way doctors are making money these days is volume. If you see 30 patients a day, at 6:00 you go to your computer and there’s 30 e-mails, God, I can’t charge for these just yet. Why would I entertain the possibility of receiving e-mails from my patients? I understand why doctors are averse to that.

The way I treat patients, I can see six to eight patients a day, and as I’m traveling, I can answer e-mails. I’ll receive forms in my e-mail from patients who want to see me in the next hour if I’m not busy. With an iPhone and a Macbook, its ridiculously easy to keep track of everything.

You obviously love New York.

I’m a big fan. It’s the center of human culture. Everything is right here. If you want to go see this really obscure movie, it’s playing down the street. If you want to see this amazing photography by the best photographer in world of all time, it’s coming to town next week.

A woman was visiting me from Ireland and said something that describes New York as a summary. She said, “The one thing I love about New York is that the answer to every question is yes. It might cost some money, but the answer is yes.” She asked if I’d been to Ireland and I said no. She said the answer to every question in Ireland is either no or maybe.

The architecture and infrastructure here is just awesome. You don’t have to have a car.

Will you stay there or go Hollywood? You could leave your practice after one month and be in the public eye constantly if you wanted, doing stuff that people only dream of.

I’m not to going to go Hollywood, at least not yet. It seems that way, doesn’t it? We’ll see what happens. If I can start some sort of system … I have ideas and I have people backing me to create something along these lines that can benefit more than the 1,000 patients I can see here.

You could easily be rich and famous.

You should see my apartment right now. [laughs] It doesn’t look like I’m rich and famous just yet. But It’s New York, where the answer to every question is yes. The opportunities for me are endless, I think.

Monday Morning Update 11/5/07

From Matthew Holt: “Re: millionth visitor. Inga, I wish I was as clever as you thought I am! I’m just feeling guilty that I’m speding too much time working and not enough flying my  paraglider. BTW why doesn’t Mr HIStalk make his Sitemeter logs public?” Easy answer on Sitemeter: I’m trying to stay anonymous and Sitemeter would display my IP address, location, and (if I got on from work), my employer to the world. That actually happened once before (a vendor told my former employer) and I’d rather not deal with that again. I can’t imagine what’s in there that would interest anyone since it barely interests me, other than to see who’s linking to HIStalk.

From hit-investor: “Re: athenahealth. Guess the street liked ATHN’s earnings as it popped almost 11% on Friday to a 52-week high. Folks like their recurring rev model and SaaS network approach compared to Allscripts and Nextgen, which do not have a network strategy – hence lower valuation, not to mention these guys keep missing their numbers.” I must be jaded by Google since I thought a 33% revenue rise was just OK. But, they’re making money out of the gate and that’s unusual. I can see why the model of making money only as a small percentage of what your customers get is attractive (why would anyone cancel?) It’s certainly refreshing to see that instead of the usual “give us $20 million and we’ll send you some CDs” approach. I think the message is that a company willing to go on the hook with their customer for the expected benefits can do very well. But, athena’s system is plug and play and creates benefits automatically, while most hospital systems contribute only maybe 10% to the expected outcome (process change drives the rest). Think of it as HIT insurance: with traditional systems, your deductible is very high. The value of the shares Jonathan Bush still owns: $36 million.

From Lazlo Hollyfield: “Re: MGMA. The vendor hall was pretty sparse (tumbleweeds last Sunday and late Tuesday afternoon) and heard some grumblings from the vendors about it. Nowhere near the level of HIMSS. Seems that vendors had to do their work ahead of the show. Two positives, though. The leads are usually high quality and legit. Plus, a bunch of vendors mentioned that it great a great opportunity to concentrate on B2B relationships and see if there was anything really innovative. The conference attendees are mostly physician practice executives, but I didn’t see a bunch of practice executives who were MDs. Mostly business people. Seem much more savvy than your typical physician practices, though. They have already installed an EMR or are in the process of installing an EMR. Interested in a few topics educational topics and mainly socializing. Biggest themes I heard repeatedly mentioned and discussed: real-time claims, P4P, Medicare cuts, and patient-centered practice.” Thanks for the report. I always wondered why doctors don’t get someone else to manage their practices (other than their wives or mistresses, anyway) because they’re usually terrible businesspeople, despite their own flattering self-assessment. By the way, I’ll be posting my interview with “house call doctor” Jay Parkinson in a day or two. He has no office, no staff, no equipment, and takes minimal insurance, but he’s doing very well and enjoying his practice. He’s fun, and about to become a TV personality, as you’ll read shortly.

From Kip Wilson: “Re: Sunquest anonymous customer. The name is anonymous because this client does not allow their name to be used in public press releases. This client is in a big city in a rust belt state on one of the Great Lakes. Sunquest people tell me that they researched Cerner, Eclipsys, Epic, etc., and that these firms sometimes have press releases without company names, too.” It makes a crappy press release no matter who else is doing it. It just looks desperate to announce a sale in which the customer refuses to be named (how do we know it’s legit? how impressed should we be without having any details) Maybe they should include the CIO’s picture with a bag over his or her head.

From Frank Poggio: “Re: how to market IT internally. 1) stop pushing technology; 2) stop pushing departments to a ‘single’ solution and focus on their needs first, IT’s second; 3) get out into the departments and learn/understand their issues; 4) then, propose solutions, not technology; 5) if they don’t ‘see’ the solution as you do … go back to #2.”

From Isabelle Hammond: “Re: terms. Any comments on the recently announced project funded by the Office of the National Coordinator to create consensus definitions for the terms  EHR, EMR, PHR, HIE, and RHIO? Think it’s needed, or just nonsense? I’ve already heard that some folks at HL7 aren’t pleased about it.” Seems like a harmless waste of taxpayer dollars, I guess. While we jaw about the differences between EMR/EHR and HIE/RHIO on HIStalk, is anyone really all that confused, to the point of “impeding progress” as ONCHIT’s Karen Bell suggests? Is that why RHIOs (or is it HIEs?) are failing?

Speaking of NAHIT’s terminology project, the press release itself is loaded with business-babble BS (not a good sign for a terminology project announcement). My Bullfighter software summarized as follows: “Diagnosis: You overwhelmingly embrace obfuscation and don’t want the reader to understand anything you have to say. Your writing lavishes a preponderance of dependent clauses and compound negatives upon the reader, whose cognitive load not infrequently exceeds the purported benefit of the substance of the article. Syntax incorporates numerous collections of items juxtaposed or in series that demand persistence and not a little unqualified expertise on the part of all intended recipients of the author’s communications. In fact, such machinations inevitably prove detrimental to comprehension and sabotage the imparting of any and all knowledge. Your condition is irreversible.” NAHIT’s marketing person is running the project and an outside group is providing “collaboration tools and services” (guess e-mail and the telephone can’t meet the demanding needs). Apparently, defining five ubiquitous terms is a daunting challenge.

From Gunsmoke: “Re: Perot layoffs. To be accurate, Perot Systems did announce 650 layoffs in their press release: ‘These actions will include the termination of employment of approximately 650 associates.’ The number 425 is also mentioned later inthe release as being ‘beneficial to future earnings.’ I’m not sure what that says about the other 225!”

People keep writing about Misys Connect without understanding what it is. It’s not an EMR, a practice managment system, a portal, or anything that would interest a physician. It’s a connectivity tool that uses the federated model (you decide with whom to share your practice’s data). What a doctor would need to use it: (1) an EMR (big hurdle right there); (2) an interest in sharing information with somebody else, like a hospital (maybe an even bigger hurdle); (3) technical resources to get it connected, especially if your EMR isn’t Misys (Misys hopes to profit from either the resources or the Misys EMR option). Also what it isn’t: likely to spur EMR adoption.

Booked my HIMSS hotel this week. I’ll say one thing about Orlando: hotels are cheap. I’ve also got a potential sponsor for some kind of HIStalk reader event, details not yet determined. It never occurred to me that someone might want to help out, so I appreciate that and I hope it works out. I’ve also received some good PR ideas, some involving strippers (those suggestions always catch my eye).

I’m still playing Love’s live “Forever Changes” concert album nearly constantly. Want to see the 58-year-old Arthur Lee (now deceased) rocking a festival crowd in Europe with his 36-year-old music? I’ve played it at least 100 times and I’m still amazed.

A JAMA reader editorial called “The GAAP in Quality Measurement and Reporting” says that standards for quality reporting need to be better defined since public reporting puts money on the line (and therefore encourages favorable self-interpretation). Also mentioned: some widely used measures don’t correlate well with outcomes, checking a box that smoking cessation counseling was done says little about its quality or impact, and having an order for DVT prophylaxis isn’t the same as knowing it was actually given every day. Thanks to CMIO Mike for sending it my way.

The set of TV’s Grey’s Anatomy now features Epic Systems, which provided screen shots for the show’s hospital computers.

A New York health official says EMR systems, including CCHIT-certified ones, are missing four features needed for population-based health: structured data collection, the ability to create registry lists, built-in quality measurement, and decision support tools. It says it’s working with its unnamed vendor (eClinicalWorks) to implement those features.

Virtua Healthcare (NJ) claims its planned $500 million medical campus will transform healthcare. Mostly it sounded like tablet PCs, cameras in rooms, and patient records access. Half a billion dollars for 368 beds is quite a Taj Mahospital, but after all, they had to have a hotel and conference center. GE’s providing the IT, which apparently caused doctors to get giddy with anticipation for all the time they’ll save (we’ll check back later).

Siemens is restructuring worldwide, with thousands of layoffs coming. You’re too late if you didn’t already get your bribe.

A New Zealand hospital loses everything on its storage area network when two disks fail.

Odd lawsuit: a dentist’s drill bit breaks off during a tooth extraction. He tries to pull it out, but pushes it through the patient’s sinus and lodges it near her eye. The patient claims he told her she would sneeze it out eventually, but then told her to go the ER. The woman claims the dentist was dancing to the song “Car Wash” that playing on the radio at the time.

Philips will sell its 70% stake in transcription company MedQuist, for which it paid $1.2 billion in 2000 (now worth about 75% less). Philips has figured out how to make millions in healthcare IT: start with billions and wait for the accounting scandal. You know Nuance will be all over that one.

E-mail me.

Inga’s Update

Misys’ Center for Community Health Leadership selected Tampa Bay for a $3 million software grant. The grant will be used to accelerate EHR adoption.

Speaking of Misys, their top guy Vern Davenport is quoted in Health Data Management as saying building community connectivity before most physician groups have implemented EHRs “is solving the wrong problem.” Now we know why Misys is giving away Connect! I guess Vern realized the reason no one was buying Connect was because communities didn’t any doctors for connecting. So, why not give away a product that doesn’t solve the right problem?

Boston-area Healthcare South selects Nightingale for their EMR/PM ASP solution. Healthcare South is a 45-provider group practice and over the next 2-1/2 years will pay $475K, plus training and implementation costs.

Eclipsys Sunrise Clinical Manager and Sunrise Pharmacy are up and running at Trinitas Hospital in Elizabeth, NJ. Trinitas is using Eclipsys’ remote hosting services to process more than 6,500 orders daily.

Summa Health Care is also operational on Eclipsys Clinical Manager and Knowledge-Based CPOE. Summa claims more than 95% physician adoption after four weeks of use. Summa has also collected some interesting before and after stats, both clinical and financial.

Third quarter results for Eclipsys: revenues up 11.5% over Q3 2006. Net income was $8.9 million or $.17/share compared to $5.6 million and $.11/share last year.

E-mail Inga.

News 11/2/07

From The PACS Designer: “Re: SaaS. The fairly young industry of Software as a Service (SaaS) is experiencing renewed focus for several reasons. The most prominent is DRA-2005, which has many institutions struggling to avoid losing money from operations. With SaaS, the spending can be from operating budgets, thus avoiding the RFP capital expenditures process. Also, since SaaS can be ordered for specified time periods, you can avoid the forklift upgrade scenario which has been all too common. When signing up for SaaS, it is important that data belonging to the buyer is addressed in the purchasing agreement to protect the institution and also patient confidentiality  Other benefits of SaaS are educating the user on new concepts, exposing weaknesses in current operations, and improving the integration of existing processes.”

From DRPend: “Re: who should run clinical systems projects. The best choice would be A & B One of my first projects was as a system manager implementing a new lab system in a hospital that was using paper forms. One of my first tasks was to integrate with the hospital’s IT department and make use of shared resources. I handled clinical decisions and they handled IT decisions and the project went quite well. Who was in charge? Doesn’t matter. The doctors and patients got what was needed and we all were better off for it.”

From ERMurse: “Re: UCDMC. Congratulations to UCDMC for consolidating all their IS operations under one CIO. Tinstman (who now works as a Senior Advisor, aka consultant’s consultant at HealthTech in San Francisco) only ran the CIS portion. CIS, IS, and Campus IT had separate CIOs, for lack of a better term. The new org structure brings them together. Hopefully Minear is up for the task of uniting three kingdoms. On a less flattering note for UCDMC, their Customer Service (Help Desk) manager and another IS employee have been fired and are under criminal investigation accused of diverting high value equiptment and selling it on Ebay and Craigslist.” Link. Someone sent me an internal e-mail about the investigation in which IT employees were cautioned to decline to comment to reporters (good idea). The hospital refused to let the TV station inside to ask questions (another good idea).

From Larry Cotton: “Re: guerrilla activities at HIMSS. I can’t help thinking of the ploy in The Thomas Crown Affair (at least the Pierce Brosnan one) where a whole *bunch* of people wear similar outfits to confuse people. I’m sure you and Inga look just like Brosnan and Renee Russo. Do you look good in a derby?” Does anyone, other than John Steed from The Avengers, or maybe Mr. French from Family Affair, look good in a derby? HIMSS shameless PR activity ideas are welcome (nothing that would get me arrested or escorted off the property, please – a hallmark of a memorable prank is that it has to be good-natured and fun).

Sumter Regional Hospital is doing well in the contest to win an MRI. Discovered: once you’ve watched their video the first time and voted, you can vote on subsequent days without watching first. Just click the Vote button beside the video (without launching it). Sumter has 54,000 votes compared to 24,000 for #2, but voting isn’t over until December 31. The CEO writes an article about it for the local paper. The hospitals almost-new MRI got destroyed along with everything else in the tornado, he says.

Misys shuffles Charles Lambert out the door and brings in Ron Scarboro as CFO. He’s spent time at TriZetto and A4.

The layoffs at Perot Systems were related to Q3 earnings: revenue up 12%, EPS $0.20 vs. $0.00, missing expectations of $0.22. Loss of the Triad contract upon that company’s merger with Community Health Systems hurt them, obviously, even though that deal was break-even for Q3, according to the announcement. Perot claims headcount reduction of 425, Forbes says 650, and others confirmed the 1,000 I heard. Hardly a bloodbath given its 21,000 employees, unless you’re one of those affected, anyway. The stock hit a 52-week low today.

Thanks to hitpUNDIT for submitting a Rumor Report form to alert me of the CSC-FCG announcement. I’m usually at work when stuff like this is announced early on a weekday, so it’s the Rumor Report forms or e-mails that usually let me know something has happened. Much appreciated. I usually manage to scoop almost everybody for that reason, getting an e-mail update out quickly.

New hires at Lucida Healthcare: Wesley Knox joins as career advisor (former VP of MaxIT, Primetech Consulting, and Per-Se) and Alex Johnas as director of professional services (formerly with IBM Healthlink, Hayes Management Consulting, and East Boston Neighborhood Health Center). Bruce Cerullo hires great people.

A reader who’s doing a HIMSS presentation on marketing the hospital IT department internally would appreciate any ideas from readers who have come up with cool ways to do this. My contribution: an IT Annual Report, and IT Report Card, a system-naming contest (lame), and a CIO blog. Anybody have other ideas? Submit by e-mail or by the Rumor Report form to your right.

VISICU gets a new patent for its technologies, apparently putting the annoying challenges behind it for good. I mentioned the company’s technology indirectly in my editorial for Inside Healthcare Computing this week: “Outsourcing Pharmacist Order Entry: Why Technology-Driven Clinician Virtualization Will Increase Costs Instead of Lowering Them.” The publisher says someone observed that I’m too cynical, although this was one of my less-cynical editorials. The good news is that there are plenty of naive cheerleaders and company shills out there to offset my darkness. Plus, on those rare occasions where I’m slightly positive, you know I’m really stoked.

McKesson’s Q2 numbers: revenue up 9%, EPS $0.83 vs. $0.75. Shares were up 13% Wednesday and gave back a little today in a hugely down market.

HIMSS signs a deal with the Saudi Association for Health Informatics to offer training there.

Yesterday was the last day at Epic Systems for former Madison mayor and liberal activist Paul Soglin.

ZDNet says Misys is now an open source HIT competitor to Medsphere, missing the point completely that all they’re offering is some interoperability software, something the average doctor has never heard of and doesn’t want. I would be at least a tiny bit impressed if the company open sourced something that might actually increase EMR adoption, like one of its stable of poorly selling EMR applications. This is like someone claiming to be an open source evangelist because they loaded Firefox onto their Vista/Office PC.

The former compliance officer of Queen’s Medical Center (HI) is indicted for mail fraud after awarding $600,000 worth of compliance and HIPAA consulting contracts to companies she started. She says everybody knew the deal when they signed the agreements. She’s going after another $2.2 million for services she said she provided to the hospital.

Listening: Andromeda, Swedish prog-metal.

AMICAS Q3: revenue up 13%, EPS $0.01 vs. $0.01.

The Army’s MC4 combat EMR is rolled out to the Air Force’s 332nd Expeditionary Medical Support Group and an Air Force hospital in Iraq.

Meditech’s Q3 report: revenue up 6%, EPS $0.59 vs. $0.61. Services revenue saved what would have been a rare bad quarter.

SAP says it will release e-health solutions in Europe, whatever that means (no clinical systems, the CEO says). Pilots will start in December, apparently mostly in Germany. The company admitted that its joint US project with Siemens went nowhere, er, “it would be exaggerated to say that we are fully satisfied with how things developed.” Anyone shocked? That’s like a restaurant serving liver with a broccoli sauce.

Speaking of Siemens partners, patient monitor maker Draegerwerk AG’s shares tank after poor results from the chunk of Draeger Medical it bought from Siemen AG. We Americans were the problem once again.

GE Healthcare will work with an art school on home healthcare solutions.

Siemens and Merrill Lynch put in a bid of $275 million to buy three small California hospitals, intentions unknown.

InterSystems receives a 2007 Pro Bono Award for its support of The Legal Aid Society through donation of Cache’ technology and services.

Quality Systems’s Q2 numbers: revenue up 21%, EPS $0.35 vs. $0.30. Its NextGen division contributed $15.7 million in profit, with revenue up 23% and net income up 12%.

BridgeForward announces an embeddable version of its ClearSpan Server interface engine at MGMA. Sounds cool and eScription’s Paul Egerman chips in some nice comments. I see the founder and CEO had the same roles at MicroScript, later bought by high-flyer and eventual flop New Era of Networks NEON, which ended up as part of Sybase.

I’ve lauded Sunquest mostly just for bringing back the old name, but now it’s time to take them to task: the company issues a glowing sales announcement but refuses to give the customer’s name. Was someone ashamed? Will the implementors wear blindfolds? Is good news so scarce that partial news will have to do?

I’ve grown weary of reporting the accounting debacles of Merge Technologies (restatements, delisting threats, etc.). They’re restating again, driving an already pitiful market cap and share price even lower: $63 million and $1.96, respectively.

E-mail me.

Inga’s Update

From Inside Outsider: I read your post on HIStalk about the HIT executive trying to hook up with the young ladies at the conference. I have to ask: Do you think this is an isolated incident? It seems that every conference I’ve ever been to has the illicit hookups going on. You’d almost expect that they would have a bulletin board for people looking for people, it happens so often. I think that some go to the conferences and never go to a meeting. And the funny thing is that the people think they are being sly and that no one knows. EVERYONE KNOWS!!!

Mediware announces they paid about $5.2 million for newly acquired Integrated Marketing Solutions.

I was glad to see that I wasn’t the only person unimpressed by the HHS/CMS plan to provide 1200 physicians bonuses for quality reporting using EMRs. At least a couple of industry big-wigs agree with me that a program that offers incentives for less than 1% of US doctors is a pretty small gesture.

athenahealth announces Q3 results. Revenue was up 33% year on year, quarterly adjusted EBITDA was $4.2 million (16% of revenue) and their first quarter of net income ($500k). GAAP net loss for the first three quarters combined was $5.6 million.

Matthew Holt sent in a note about a graphical inaccuracy in Medicity’s parachute ad. My first thought was, “Who cares?” followed by, “Why would Matt waste his time pointing that out instead of working on his 2.0 updates?” Then I noticed he submitted his post around 3 a.m. Wednesday, just about the time HIStalk’s 1,000,000^th visitor came by. Matt Holt was trying to be HIStalk’s millionth visitor! Thought it was kind of sweet of him, actually. Made me a bit ver clemped once I put it all together.

E-mail Inga.

CSC To Acquire First Consulting Group

Computer Sciences Corporation announced this morning that it will acquire First Consulting Group for $365 million in cash, subject to shareholder and regulatory approval.

“By taking this step, we have notably accelerated our healthcare business plan and advanced toward our goal of transforming healthcare through the use of information technology,” said Russ Owen, president of CSC’s Americas Commercial Group. “The CSC-First Consulting Group combination reinforces our commitment to bring innovative solutions to healthcare payer, provider and life sciences clients and offers increased flexibility in our global healthcare service delivery capability.”

News 10/31/07

From Dr. Lisa Cutty: “Re: Microsoft. Microsoft to Acquire Innovative Healthcare Technology and Assets From Global Care Solutions. Does MS really want to enter the battled HIS arena?” Link. MSFT buys the application developer that built systems for big-name medical tourism magnet Bumrungrad International Hospital. For the dirt on the company, see here from alleged employees, and a few more comments here including some shots at Cerner and others. I don’t know why Microsoft wants to be in this business either, although maybe Azyxxi needs a little brother.

From Big Fan: “Re: first mover advantage. Check out Bruce Freidman’s column from the weekend. Great insight. He’s also from University of Michigan, the lab side, and was department head when they decided to back out their Millennium PathNet upgrade. I’d like to hear his explanation for that.” Bruce argues that companies that develop their own IT systems often regret it because commercial offerings will eventually surpass them. He cites an article that claims Wal-Mart’s much-lauded internally developed IT systems now place the company at a disadvantage. I don’t know that I necessarily agree since even a short-term competitive advantage may make self-developed applications worth it, but it’s an interesting discussion.

From M_Miller: “Re: Misys. Steve Lohr, the leading software writer for the New York Times, slams Misys’ open source idea. Everyone knows that Newt is paid to give these quotes to Misys and Allscripts as part of his lame group, but man, Misys just can’t catch a break. The piece then goes on to call out athena’s model and Jonathan Bush’s take on what needs to be done.” The article agrees with me: dumping a poor-selling product onto the open source market doesn’t usually work. There’s no passionate developer community behind it. The article mentions Gartner’s Wes Rishel, who was “unimpressed” and who brought up that users would be clinicians, not the usual techies who embrace that kind of stuff (so he says, anyway, although that’s not what I thought Connect was). He likes Web-based SaaS technology. Sad that the Connect strategy was the supposed future of Misys Healthcare just a few months ago and now the related accoutrements have been donated like a rusted out Chevette.

And speaking of Misys, CFO Charles Lambert has been officially announced as departing, I’m told.

Former University of Maryland Medical Center CIO Mike Minear is named CIO of UC Davis Health System. If you want excruciating detail of what he’s being paid, see here (warning: PDF). He replaces Tom Tinstman (previous HIStalk mentions here).

This week’s Brev+IT is here. Sign up to your right.

Listening: new Coheed & Cambria. I’m in a prog-metal mood.

KU Hospital and KU Medical Center did nothing wrong in choosing a $50 million hospital system from Epic Systems despite a lower bid from Cerner, according to a report by state auditors. Cerner was somewhere between $1 million and $12 million cheaper than Epic over five years, but users had a strong preference for Epic.

The folks at Medicity, always anxious to be helpful, think they may have a few “I Am Mr. HIStalk” buttons laying around and offered to mail one to Lacey Underall if so. No promises, Lacey, but send me an address and we’ll see. I’m still trying to think of something fun and slighly guerrilla-ish to do at HIMSS. Many I should hire an obnoxious band to play on a flatbed truck outside the convention center (I’d be stealing the idea from Howard Stern). Or, I could offer speakers an under-the-table $50 to slip an HIStalk pitch into their PowerPoints and claim it was a mistake (it was a proud moment last year when my man John Glaser wore his button up on stage). Inga and I will be running around causing anonymous trouble, I guess.

A big year for SCI Solutions – their biggest ever, actually. They signed 33 new contracts, including Sutter, UVA, and Health First. Nice.

Justen Deal has thoughts on Kaiser’s potential outsourcing, “Together Again: KP and IBM.” He mentions IBM’s offshore presence (could that be a way for KP to offshore without taking the black eye it might bring?) Spoiler: Justen thinks that bringing in IBM would be good for both KP and Epic.

Rumor: Perot is laying off 1,000 people. Reason unknown.

Want to follow HIT stocks? I made a page with the big HIT stocks listed and a 20-minute delayed quote. Bookmark it if you’re so inclined.

The local paper profiles eClinicalWorks: 32 profitable quarters, 3,000 customers, 600% revenue growth in three years up to $38 million, and a tripling of employees to 550 in two years.

Miami Children’s hires a former GE Healthcare guy as CEO: M. Narendra Kini, MD.

To your right is a new poll: who should run clinical systems projects in hospitals? And to your left is a new Gold Sponsor, AT&T, which has mobility and wireless offerings for healthcare organizations. Hey, they’re my cell provider, so here’s a shout out and thanks for supporting HIStalk.

Sumter Regional Hospital is in first place to win an MRI machine. You can vote daily through December 31.

E-mail me. Happy Halloween, if you’re into evil undead and candy.


Inga’s Update

I reached out to a few folks asking their opinion of the status of the Kaiser/Epic implementation. Here is a note from someone who has been involved:

So the truth is that KP has successfully implemented more software in the past three years than they had in the previous 10 years. When you think about their size and compare that to anyone else, this has got to amaze anyone who really knows what this takes. They have had to industrialize their infrastructure to support the heavier load, and there have been a few hiccups with that infrastructure work, but they have already realized enormous benefits of this investment … it has been an unqualified success. Every installation of electronic health records requires physicians to significantly change their behavior in order to adopt and optimize the use of the system. The vast majority of KP docs who have used the system for more than six months adamantly reject any thoughts of going back to paper, but the changes involved in a deployment of this size invariably results in individual physicians who actively and vocally resist the change. The most surprising thing is how quickly the overwhelming majority of docs get past this reflex resistance to change.

If anyone else cares to share an opinion, we are happy to listen.

I have been mulling over the announcement that the HHS and CMS will pay 1,200 physicians for reporting quality measures using their EHRs. The government is calling it the “largest step yet” for boosting physician adoption (though if the country has 800,000 active physicians, helping 1,200 doesn’t seem that big a step.) The program will supposedly pay for itself with the reduction of duplication tests, ER visits, and medication errors. I realize that some private insurance companies offer quality care bonuses, but if there was that much of a savings wouldn’t all the insurance companies be jumping on the bonus bandwagon? I am all for using EMRs and agree they can improve care. But is there enough to this initiative to have any real affect?

All you ambulatory fans know that the MGMA has been in full swing this week in Philadelphia. Consequently, vendors are making numerous company and product announcements. A sampling:

Greenway Medical Technologies announces that Q1 sales were up 64% over the previous year.

Athenahealth announces that the 38-provider orthopedic clinic Campbell Clinic selected athenahealth’s PM and collection solutions.

Offering software as a service is suddenly fashionable. Sage Healthcare, Allscripts, and McKesson all announced new ASP offerings for their EMR/PM solutions.

Remember eClinicalWorks? From December until May, ECW was announcing one major deal after another. Since the summer, little news has been reported (Busy implementing? Marketing department on vacation? No big sales to announce?) ECW reappeared this week, announcing their partnership with the Hudson Valley HIE to provide the member doctors ECW’s EMR/PM system.

What is old is hip again! Demand for vinyl records is on the rise. Music purists are convincing more people that the sound quality is superior with analog recordings compared to the digital CD. I would bet money that Mr. H has a huge stack of Pink Floyd and Jimi Hendrix albums that he secretly listens to while writing HIStalk posts.

Heard that at a user conference not so long ago, a certain married, male HIT executive was busy sending text messages to some participants at 3 a.m., asking if they were “ready to party.” Anyone care to guess whether or not the recipients were young, attractive, and female (and if they ignored the message?)

Another fun game – fill in the blanks. I heard that [executive] is asking [beancounter] to do some things regarding revenue recognition that [beancounter] is not comfortable with; e.g., recognizing revenue a little on the early side. And, [company] just downgraded their forecast.

E-mail Inga.

Monday Morning Update 10/29/07

From Jennifer DeNuccio: “Re: athenahealth. On fire.” Link. Shares added 4.1% Friday, closing at $40.60.

From LaDonna Fredericks: “Re: running implementation projects outside of the IS department. We did this, but IS is responsible for all support, including the new system, leaving them unprepared to support the new application. The implementation group doesn’t care because they’re running the project, not supporting production, so they have no interest in making decisions based on what’s supportable. That’s why our database installation is inappropriate for an organization our side. Plus, a rift has been created between the implementation’s group fantasy and the IS reality. Consultants are coming to bail out the ‘new and improved’ project scope.”

From Muffy Tepperman: “Re: Misys. Upcoming departures: Mike Pritts (development VP) and Neal DeRozario (CIO).”

From Dr. Mark Craig: “Re: Kaiser. Croc is partially correct. The merger is responsible for some efficency cuts, but each IT VP and their units were mandated to make cuts and most units have nothing to do with HealthConnect. The prevalent rumor is that the new CIO and his new hires are on an outsourcing train and the train is powered by IBM.”

From John Ulasewicz: “Re: PHR. Here’s what I’d buy for my aging parents: a PHR with links to local services so that the individual’s family could keep in touch with social services, the grocery delivery people, etc. A software blackboard on the site would allow those participating in the care to post any issues, reassuring comments, notes that the lawn is getting mowed and the newspapers picked up, etc. Anything that saves an emergency trip would be worth it.”

From Lacey Underall: “Re: HIMSS. What about the worker-bees that never go to HIMSS? I’m just sitting in my cube coding my tail off all day. I’d love an “I Am Mr. HIStalk” button. Are you going to make me scrounge around on Ebay or will you start selling them from your blog?” I think I tossed all the buttons because they were a depressing reminder of the lack of interest in them at HIMSS, where for two years I tried to get the 1,000 or so of them onto lapels with minimal success. Maybe a new giveaway is needed that doesn’t involve shipping heavy buttons to convention centers (and back).

From Abe Froman: “Re: MRI contest. I hadn’t gone through all the videos to realize that Sumter Regional was in the running. Thanks for pointing it out. I will be sure to – as they say in Chicago – vote early and vote often.” Link. Choose Sumter Regional Hospital from the drop-down, watch the two-minute video (which is good), and click Vote. You can vote once a day from a given PC through December 31. I’m sure the other contestants deserve a free MRI machine too, but I have to root for the hospital that doesn’t even have a permanent building to work from.

From Marshall Blechtman: “Re: PHR. CVS/Caremark will be launching a PHR in 2008. With access to health plan claims data and PBM data, they plan to incorporate healthcare financial planning (HSA) and disease management guidance. I think the guidance will include taking more pills.  ;)” I’m already sick of the proliferation of PHRs. Even if folks wanted to use them, surely they’d be confused by competing services. Maybe CCHIT should certify them since they’re not interoperable and many are likely to fail.

From Rob Donovan: “Re: CIO. Larry Stofko has been named CIO at St. Joseph Health System in Orange County. Removes the interim title.”

New Medsphere CEO Mike Doyle predicts that the company, which he claims is the only open source provider in HIT, will be the largest healthcare IT vendor.

Reminder: most HIStalk postings (especially if you’re reading on HIStalk2) have several reader comments at the bottom. Worth your time to peruse, even though I sometimes put one right here in the main body of HIStalk because it tickles my fancy.

WSJ says McKesson’s low debt, reasonable share price, and hefty HIT profits could make the company a private equity takeover target.

Premise is #71 in Deloitte’s 2007 Fast Technology 500.

Kaiser-Santa Clara is fined $25,000 by the state health department for killing a seven-week old baby with nutritional and medication overdoses, one 25x the prescribed amount, the other 9x. Kaiser admitted the mistake, but is appealing the fine. Shands UF kills a three-year-old with 10x overdose of arginine on October 10, for which it has already apologized, admitted responsibility, placed a pharmacist and nurse on leave, and settled with the family. The newspaper also reports that “Medications for intravenous infusions must now be reviewed by the pharmacy manager”, which seems unlikely given the huge volumes involved at Shands and the questionable value added in making one person the bottleneck.

An assistant to the MIS director of New York City’s chief medical examiner pleads guilty to embezzlement, money laundering, and conspiracy for her involvement in a scheme to steal part of FEMA’s $46 million in 9/11 relief funds intended for forensic information systems. Her boss goes on trial next month.

Texas Department of State Health Services will implement Mediware’s mediMAR in 11 hospitals.

E-mail me.

Inga’s Update

From Wompa1, in response to Mr. H’s comment that I am ambulatory-centric: “I remember thinking the same thing, but I love it. Having been in a number of large, inpatient, IT projects over the years, it is easy to breeze by the clinics. However, I can’t tell you how many projects I have seen lately involving NextGen, Epic, Allscripts, Logician/Centricity, and Healthmatics. In the monkey-see-monkey-do world of health IT, clearly the ambulatory side is picking up speed. The readers are happy to have you, and the perspective. Keep it up! We’re reading. I also agree with you on the notion that the inpatient people think they are more important.”

Here‘s an interesting article on software-as-a-service vs. packaged applications. Jonathan Bush is quoted with this summary. “In Bush’s view, the Web equivalent of old-school software would be Yahoo charging $2,000 a seat for the ability to look up directions, rather than offering a free online mapping tool as it does today.” Microsoft CEO Steve Ballmer disagrees, of course.

E-mail Inga.

News 10/26/07

From Eustice McGargle: “Re: PHRs. Here in SW Florida, a local physician developed a system for his own office. He then offered a PHR function to his patients. He has 400 of them paying $10 a month for access. It turns out that the demand is not so much from his patients but from their families up north, who use it to monitor mom and dad.” Now that’s an interesting angle: a parent’s healthcare report card for their kids to sign. There’s a definite marketing opportunity there. A smart doc could provide a value-added service by putting in a short note of status and concerns for the children to read once a month or so, giving them peace of mind.

From Tony Montana: “Re: PHRs. The adoption rate seems to be 4-6% overall. What we don’t know is the long-term utilization rate, which I bet will be horrible. People won’t use PHRs unless they have a compelling clinical need and benefit and most don’t.” That’s a challenge: if few people use them at all and even fewer use them religiously, integration with practice EMRs better be good enough so that docs don’t waste time checking, only to find nothing useful. People are vitally interested and motivated in healthcare only when they’ve been hit with life-changing health news. Lots of folks have a frenetic burst of fact-finding about glucometers, vitamins, and prescription meds right after they get them, but then lose interest once they realize their mortality is not imminently threatened.

From Stagger Lee: “Re: Susquehanna. Susquehanna Health VP/CMIO Angela Nicholas has announced her resignation. She has accepted a position with Siemens and will be working for Pamela R. Wirth, Susquehanna’s former VP/CIO who left for Siemens in 2005.” The hospital must be OK with it. Or, they should have written a better contract prohibiting hiring their employees.

From Abe Froman: “Re: Siemens. a gotta love Siemens. What’s next – will they try to get Disney to change their Soarin ride to Soarian?” Link. Siemens is running a contest in which hospitals of under 180 beds can win a free Magnetom Essenza MRI if their video of why they need one wins the most votes. It’s complete with hints on how to publicize the contest to the local newspaper and on YouTube. You can view the submissions on the site. Some are funny, with “we’re hicks” seeming to be the most common theme. The one from Clay County Medical Center (KS) called ‘Granny Gets and MRI’ is like an old-time silent movie and was pretty good. Leading is Murray County Memorial Hospital (MN) with ‘MCTV Cribs,’ which is nicely done. Last day to submit is November 30.

And speaking of Siemens videos: Marcus Johnson, one of our HIStalk friends at Sumter Regional Hospital (to which HIStalk readers donated $11,264 in March – thank you – after a tornado destroyed the hospital) is in the hunt for a free MRI. Pick Sumter Regional Hospital from the drop-down, watch their video, then vote for them like I did. The video is serious, showing the effects of the tornado and narrated by the CEO. You can vote once per day from a given PC.

From Crocodile Hunter: “Re: Kaiser. There are lots of organizational changes going on, the merging of KP HealthConnect into the IT organization being one of the biggies. The layoffs are mostly from the consolidation of organizations. But in reality, a hundred positions out of the thousands that work in IT is  much less than the normal attrition rate. So, you might suggest that the merger of HealthConnect into IT is actually the bigger story here, not the layoffs.” It’s interesting that both Kaiser and Allina implemented Epic outside of the IT department, which I think is a great idea. IT departments don’t have the vision, influence, and resources to run a big clinical systems project, so carving it out means the hospital has to fund and staff the project in an easily auditable way.

From Soul Survivor: “Re: Misys. Nice move by Misys to open source Connect. They should consider doing the same for Tiger, Vision, and Misys EMR. No one buys those products either. The mandate is out that PTO (paid time off) will be used or paid at 50 cents on the dollar. Old sales commissions being settled. Auction to follow?” Unverified.
HIMSS will offer a MS-HUG Tech Forum on Sunday of the HIMSS annual conference, with sharing of best practices by users.

Speaking of HIMSS, I had a good time at the conference last year, I must say. It was cool seeing a big old HIStalk logo on the athenahealth booth with CEO Jonathan Bush yakking with HIStalk readers and having a bartender giving them expensive beers. And, seeing the “I Am Mr. HIStalk” buttons in the booths of Medicity and Picis. Since I’m incognito, that’s about all there was from the HIStalk front. Inga and I talked about throwing some kind of bash at HIMSS, but it’s so hard (and expensive) to get any sort of space. We’re open for ideas. Inga loves that schmoozing stuff.

Cerner chief marketing officer Don Trigg is re-elected to the board of the Greater Kansas City Chamber of Commerce.

Sponsor note: thanks to SolCom for upgrading their banner ad to become an HIStalk Gold Sponsor. I appreciate their long history of support. They just signed a big deal with William Osler for HIM and workflow solutions, which I mentioned earlier.

Sponsor note II: welcome and thanks to NextGen, HIStalk’s newest Platinum Sponsor. One of very few companies with a 2007 CCHIT certification for ambulatory EMR, #5 on the list of Forbes best companies, and a juggernaut in the physician systems market. Parent Quality Systems Inc. has a market cap of $1 billion, $163 million in revenue, and stellar return on investment and return on equity for you stock watchers. Many thanks to NextGen for spending a few of their ad dollars wisely by sponsoring HIStalk and its readers.

Here’s the most recent Brev+IT, available last weekend to those subscribing for free (see signup to your right). I haven’t check the signup stats lately, so here goes: HIStalk 3,206; Brev+IT 985. I’m sure there are some spammers on there, but that’s still encouraging and I appreciate it. I remember when the HIStalk list got up to 31 readers – I was insufferably happy to have folks who cared enough to sign up.

Idea: the people most interested in researching their own medical conditions connect via a growing number of disease-specific support and advocacy groups. Maybe those groups will provide or sponsor their own PHR.

Misys will make its Connect software available as open source through a new division called Misys Open Source Solutions. The devil’s in the details, though, and none were provided. Also announced by Misys: Misys MyWay, a hosted EMR for small practices (the renamed iMedica, I assume). The press release says a family of MyWay offerings is coming, so maybe they’re buying someone (the imminent ‘big announcement’ rumor is still out there). if someone appropriately cynical and musical wants to compose alternative lyrics to Frank Sinatra’s My Way, I’m sure there’s material for it in the announcement.

HIMSS announces an survey of its pet-named EMEA (Europe, Middle East, and Africa). Two priorities emerged: implementing regional/national EMRs and home care monitoring.

Retired CIO and now apparent consultant Peter Strombom is insulted that the state of Wisconsin is offering only $10 million in tax credits for EMR-adopting providers. That’s the bad thing about government welfare for businesses – they always want more. If it were my state tax dollars, I’m not sure I’d want profitable non-profit hospitals getting a handout of my money to buy business equipment.

The selection of six EMR companies for British Columbia doctors to choose from is contested, with the $108 million contract resulting in two resignations, an audit, and a suspicious check. Said one CEO whose company was not chosen: “This thing … makes me want to puke.”

An Indiana doc caught by the local newspaper putting medical records in a Dumpster says he’ll dispose of them properly (having been caught in the act). He was kind of an ass with the press, which is never a good idea: “This is a private houseekeeping matter and none of anyone’s business.” So, naturally the paper contacted some of his patients and goaded them into being outraged, printing their scolding comments along with HHS’s telephone number just in case anyone is interested in filing HIPAA complaints.

It’s a mystery: a nurse notices a vanload of men outside the hospital at 3 a.m. She sees a bunch of laptops and they say they’ve been hired to work on the hospital’s wireless network, then took off. The hospital says someone has been trying to hack its network.

Interesting: Stanford researchers figure out how to derive new data from old genetic experiments, coming up with some new discoveries from discarded data.

For all you Health 2.0 fanboys: a 31-year-old New York doctor practices only on the Web and via housecalls. His “eVisits” are conducted by video chat, IM, and e-mail, with his target patients being under 40 and located nearby. I’ve e-mailed to ask for an interview and he’s given a tentative OK (about five minutes after I e-mailed him, a good sign for an e-doc). It’s a brilliant, lifestyle-friendly practice idea, so I’m really interested in how it works for him and his patients. More to come, I hope.

If you signed up for the CCS Summit, Andy Eckert from Eclipsys has joined the CEO Power Session (with Jonathan Bush of athenahealth, Jeff McCaulley of Wolters Kluwer Health, and Glen Tullman of Allscripts). HIStalk is a sponsor, and given my lack of decorum, I decided to crash the party hard in my writeup instead of being button-down serious: “HIStalk is written by and for IT professionals and clinicians with 50,000 visits monthly. No fluff or press releases – just breaking news, deadly accurate industry rumors, expert opinion, and CEO interviews. We know the healthcare IT industry because we work in it. Your competitors hope you don’t read it!” Too brash?

E-mail me. I need your rumors and ideas.

Inga’s Update

MEDecision, Inc. announces their 3rd quarter financial results, and they weren’t too pretty. Net loss for Q3 was $2.92 million and total revenue was $9 million versus $12 million in 2006. For the fiscal year 2007, the company is forecasting an operating loss in the $4-6 million range.

Recently Mr. H told me I was very “ambulatory-centric.” I think he meant it in a derogatory way, as if people preferring the world outside of hospitals are somehow inferior to those dedicated to the inpatient setting. I wonder if that’s his unique personal quirk or if all hospital-types have the same bias.

So, if you are like Mr. H and bored by the ambulatory stuff, skip this next bit. iMedica announced the addition of 39 new practices for Q3, which is a 131% increase from same period in 2006. No mention how that translates to revenues and profits, however. It should be interesting to see how the Misys alliance affects the company in terms of sales and financial performance.

Just released: The MRI 2007 Survey OF EMR Trends and Usage. Some interesting findings include:

• The major factors driving EMR adoption in the hospital segment include patient safety considerations, efficiency and convenience, and satisfaction of physicians and clinician employees
• The major factors driving EMR adoption in the medical practice segment were improved patient documentation, efficiency/convenience, and remote access to patient information
• Major barriers to implementing EMR systems were lack of adequate funding or resources, anticipated difficulties in changing to an EMR system, difficulty in creating a migration plan from paper, inability to find an EMR solution/components at an affordable cost

Hospitals need to improve compensation, staffing levels, and recognition in order to improve employee satisfaction, according to a new Press Ganey report. The report surveyed 193,000 nurses, technicians, administrative personnel and other non-clinical employees and found that registered nurses were the least happy of the bunch.

E-mail Inga.

News 10/24/07

From Ninny: “Re: NHIN. HHS’ ONC said at the NHIN Trial Implementation startup meeting on Friday that the NHIN TI awards were under protest. Who’s protesting it? Often companies protesting Federal awards publicize their efforts. ONC did say that Kaiser Permanente and ‘Federal Partners’ (VA, DoD, CMS, SSA, etc.) are also part of the NHIN Collaborative, #10 and 11. KP is footing their own way.” I’m interested in who’s protesting, if anyone knows.

From Big Fan: “Re: interview. It’d be cool if you could interview Jocelyn DeWitt at the University of Michigan. They run their own homegrown EMR and CDR, are slowly implementing Eclipsys Orders, McKesson scheduling, have over 400 employees in IT, and run a buttload of best-of-breed systems. The curious part – how can they justify all that cost and overhead, how do they keep it all running, and manage all those interfaces. Are they/have they considered consolidating on a handful of vendors?” Good idea. I shall ask Inga to attempt contact.

From The PACS Designer: “Re: PHR list. AHIMA has a myPHR page that lists free PHRs.” Link.

From Digger O’Dell: “Re: CliniComp. John Reardon is out as CEO of Clinicomp, the third person as CEO in the last 3 1/2 years (Kremsdorf, then Witonsky). The founder wishes to retain control and has reinstated some previous staff in executive roles.”

From Wompa1: “Re: GE. Any idea how many organizations are using IDXtend/classic/flowcast/Centricity Business?”

Philips unveils its CliniScape wireless handheld device. I found a picture here.

A reader sent this link, showing that EDIS vendor Emergisoft is spending $100K a year on lobbyists. I don’t know what their cause is.

I’ve gotten several e-mails wanting to know more about the rumored Kaiser layoffs and their progress with HealthConnect (apparently highly touted at Epic’s user meeting). If you have information, let me know.

Orlando Portale tells me that Pomerado Hospital in San Diego has been evacuated because of the fires there, although IT systems are running normally. A million residents have been displaced, emergency shelters are filling up, and at least 1,000 homes have burned in San Diego County alone. You know the insurance companies are already poring over policy fine print looking for ways to get out of paying fire-related claims.

Cerner’s Neal Patterson buys a 1,308 pound steer named Chuck for $150,000, obviously unaware that the market price for ground Chuck is quite a bit less than $115 per pound. Actually, kidding aside, that’s a fine gesture and true to his (previously) humble roots.

The move of Eclipsys from Boca Raton to Atlanta will cost 54 employees their jobs.

HIMSS and Microsoft are taking MS-HUG worldwide, both apparently unsatisfied with anything less than world domination.

Premise CEO Eric Rosow is profiled in a local newspaper article on entrepreneurism.

Announced HIMSS keynoters: Steve Case, Bill Frist, Rob Kolodner, Mike Leavitt, Steven Levitt, and Eric Schmidt. Numbers 1,2, and 6 add up to quite a few billion in net worth. I’m waiting to see if anyone interesting will be on the View from the Top panel (longing for the Neal and Judy days).

Initiate Systems announces GA of its Initiate Provider provider management application. Also announced: Initiate and IBM will implement its Initiate Patient EMPI at Ochsner Health System (LA). IBM’s contribution is some HealthLink mumbo jumbo intended to make consulting sound packaged and proprietary: “Prolink4 is IBM’s process-centric, top-down project methodology that works to transform organizations from current to future states based on overall goals and objectives,” aka doing Gantt charts.

AMICAS announces that it signed 15 new contracts in Q3.

The former owners of shuttered Greater Detroit Hospital are fined $1 million after an owner was caught burning piles of medical records on his farm and others were found blowing down the street.

Nuance, apparently intent on closing a new acquisition each week, announces that it will acquire call center solutions vendor Viecore.

According to poll results so far (to your right), 11% of HIStalk readers keep a reliable, electronic personal health record. Higher than I expected, maybe inflated by PHR keepers anxious to be counted. On the other hand, that means that at least 89% of healthcare technology experts, many of the clinicians and software evangelists, don’t find enough value in PHRs to keep one for themselves. So, the Joe Sixpack number is probably something far less than 11%, although that’s still potentially dozens of millions of people. If PHRs were a TV show, they’d have been cancelled already.

The new Sunquest gets its first sale, a $1.4 million LIS contract for Children’s New Orleans. In the pipeline under Misys, no doubt, but still cool.

A fun Monty Python surgery sketch, featuring the machine that goes BINGGG. Note the irony: key player Graham Chapman really was an MD.

E-mail me. I need your rumors and ideas.

Inga’s Update
Despite my glamorous image (everyone does think I am glamorous, right?) I feel like such a nerd because I got so excited by the HIMSS keynote line-up! Mike Leavitt, Dr. Kolodner, the author of Freakonomics, the Google CEO … if only they could add George Clooney coming to discuss HIPAA privacy, it would be perfect!

Zagat, the restaurant rating guys, are teaming up with Wellpoint for a doctor rating guide. Patients will be able to rate their doctors based on trust, communication, availability and office environment. Too bad they left out clinical outcomes. Would have been fun to walk into an office and say, “Doctor, I hear you do an exquisite brain surgery.”

This is such great news that I am going to eat chocolate cake tonight to celebrate! Canadian researchers claim “jolly” women (those with higher BMIs) show fewer signs of depression, anxiety and negative moods. And all this time I thought the key to happiness was being a size 4.

E-mail Inga.

Monday Morning Update 10/22/07

Investors weren’t happy that Cerner missed Q3 revenue expectations and also lowered guidance last week, even though profit was up 34%. Shares dropped 9% Friday.

An anonymous source (someone affected) says that over 100 people have been laid off from Kaiser’s IT department.

Another source tells me that Bronx-Lebanon’s Eclipsys deal was booked at $32.5 million, to answer a reader’s question.

The fox joins the chickens: the SEC director who went after McKesson HBOC for fraud will quit to work for a private investment company as its general counsel.

News bits from Medicity: their client Delaware Health Information Network gets an NHIN trial implementation grant, Medicity’s headcount will have tripled in less than three years, its product suite now supports all LDAP-compliant directory services, and it just opened a new 24×7 Network Operations Center. I had missed that CEO Kipp Lassetter will be on a panel at the Collaboration Communications Summit in Beverly Hills (November 5-6), of which HIStalk is a media partner.

An interesting report (warning: PDF) called “The Relationship Between Electronic Health Records and Patient Safety”, from Canada Health Infoway. Overview: evidence that clinical systems improve patient safety is incomplete, clinical systems may have unintended consequences, implementation should be incremental to let providers adjust, and expectations must be realistic.

Don’t forget the poll to your right on PHRs. I’m interested to know who’s using them. I only know that I’m not.

Let’s hear it for those sponsors who keep the HIStalk well flowing. Click over and take a look, and if you’re their customer, please tell them you appreciate their support of HIStalk.

Design Clinicals, LLC
EnovateIT
eScription
Hayes Management Consulting
Healthcare Growth Partners
Healthia Consulting
Inside Healthcare Computing
Intellect Resources
InterSystems
John Muir Health
Lucida Healthcare IT Group
Medicity
MedMatica Consulting Associates
Noteworthy Medical Systems
Novo Innovations
Picis
Premise
Pring|Pierce Executive Search
SCI Solutions
Sentillion
SolCom
Stratus Technologies
The White Stone Group, Inc.EHRConsultant

Baylor Health Care is #15 on the 2007 Information Week 500, the highest ranked health care system at one spot behind Google.

Surely it’s not just me: spam filters are rejecting an awful lot of e-mails. How many times lately has something you’ve sent not arrived, or has someone sworn they sent you an e-mail that you never received? I suspect those server-based spam tools are too tightly wound to let all the real e-mails through.

Another odd Misys press release: its extensive research reveals that doctors don’t use EMRs because they’re expensive and hard to use. A shocker, I know, especially coming from a company often known for trying to sell expensive, hard to use products. Here’s the research methodology used: Misys watched a bunch of cheaper, better competitors brutalize it in the marketplace. Great conclusion, but too late to keep those horses in the barn.

A European project will monitor patients at home, using sensors that report environment as well as physiology.

As I already mentioned, Medsphere settled its lawsuit with the Shreeves. You have to assume that (a) either new CEO Mike Doyle said he wasn’t coming unless they took that blot off the company’s record, or (b) it was a Ken Kizer vs. the founders grudge match with no possible winners, so his leaving the CEO post was related in some way. It’s too bad the distraction couldn’t have been ended sooner. Medsphere already had enough challenges before the suit.

Here’s yet another smart card pilot for medical records. Seems like everybody’s been trying to make smart cards do something useful for 20 years or so now. This latest one at least carries more information than just a medical record number, but it’s really just a PHR on a card that the patient can’t update, i.e. like a floppy-carrying sneakernet. Siemens is paying for the pilot.

Cardinal Health’s Medicine Shoppe will run up to 500 clinics in India’s urban slums, complete with a pharmacy, lab testing, and a doctor.

CPSI’s Q3 numbers: revenue up 2.6%, EPS $0.30 vs. $0.32.

E-mail me.

Inga’s Update

John Hallock of athenahealth dropped me a note letting me know that athena had actually announced one other group live on athenaClinicals. FirstHealth Family Center in NC is up and running at its seven facilities.

Earlier this week Mr. H mentioned a Misys press release about EMRs that he said “contains no news.” Basically true, but I what I found interesting is that the article promotes hosted EMRs, an offering Misys won’t be selling until the iMedica arrangement is finalized (not expected until November), If I were a Misys prospect buying EMR today, I might be scratching my head asking why Vern is promoting hosted solutions when they aren’t selling one yet.

Columbia University’s physician group, the Faculty Practice Organization (FPO) of the College of Physicians and Surgeons, signs a management and consulting agreement with Greencastle Consulting. Greencastle will manage FPO’s roll-out of the Allscripts TouchWorks EHR.

Medical Economics has an interesting article titled “Avoiding EHR Sticker Shock.” It provides some insight as to why various solutions may appear to have such different costs. It also suggests some less obvious components the buyer should consider when calculating the total cost of ownership.

E-mail Inga.

Art Vandelay’s Thoughts on Worker Benefits and Technology

Art Vandelay is a hospital-based technologist and HIStalk contributor.

I find the move by General Motors (GM), now Chrylser/Cerberus, and the United Auto Workers (UAW) very telling about the future of worker health care benefits and soon, very telling about the future of consumer-centric health care technology. In the end-state of the deal with GM, the UAW will assume the responsibility for retiree health benefits over the next few years. Although many other businesses have begun to reduce or eliminate their retiree health care and pension exposure, this is the first major visible movement in an industry that has reacted with the speed of a tortoise in the face of major cost challenges.

The situation for GM is daunting. For every able-bodied worker, there are four retirees. This is basically the same demographic trend that many European countries and, to a lesser extent, the U.S. face. The obvious effect of this is a growing number of Medicare beneficiaries with fewer resources paying into Medicare, while healthcare costs outpace “revenue”, i.e. our tax dollars. The moves we see from the UAW will likely be the same we see in other slow-moving industries for employees and retirees, as well as with Medicare. Undoubtedly, the UAW will push health savings account and high-deductible health maintenance organization-based plans. Both options are associated with the “consumer-directed movement”, although there are varied findings about the effectiveness of these plans depending upon one’s viewpoint ( i.e., consumer cost, payer/employer cost, quality, satisfaction).

So what can we expect as technologists?

1. There will be an unprecedented, albeit slow-moving, pressure to provide information about (first) cost, (second) quality and (third) access to care in a consumer-friendly manner. I stress, in a consumer-friendly manner. How many of us have had to explain bills, referral and authorization requirements, and the provider industry’s broken processes to parents, friends, and relatives not “in-the-know”? We will be pushed as technologists to:

• Provide natural language interfaces to knowledge bases of frequently asked questions, including providing our users with content management tools to rapidly add, edit and tag new consumer questions and our organization’s answers.
• Partner more tightly with our clinical and administrative counterparts to understand and standardize our data as well as our competitors’ available data (likely facilitated by health plans).
• Provide more data in real-time regarding cost, quality and access as opposed to data that are months or weeks old.
• Provide analysis models taking the real-time data to predict cost, quality and access challenges before they occur.
• Provide multi-factorial, consumer-friendly decision-making tools so they can use information to make educated decisions about providers and treatment options (perhaps with weighting or in conjunction with national benchmarks). Health plans will likely provide similar tools for treatment options (maybe competing tools with different outcomes) as well as tools to compare providers. Consider the challenges that group practices and other organizations with employed providers will face if they are compared to one another, as opposed to being compared as groups (everyone will want access to the provider with the best cost/quality outcome).
• Work with health plans and the government to define normalized cost and quality information for reporting (expect registry upon registry to arise – all with slightly different data definitions creating different extract, transform and load (ETL) requirements).

2. There will be an unprecedented demand to drive the work of the key knowledge workers to other, less trained, or more focused but lower-paid resources. This will be seen in as increased demand for nurse practitioners and physician assistants in many additional care settings. Nurses will likely become the care coordination coaches for the inpatient experience, running entire teams of partially specialized resources. Other disciplines with limited use of technicians will likely develop the roles. These will result in rapidly changing staffing models. We will be pushed as technologists to:

• Define role-based access relationships for users (consider this a wake-up call for those of us with applications that do not have fine-grained role-based access control).
• Provide aids in applications to guide users through the use of a system or the execution of processes, including the integration and use of workflows.
• Provide activity-based cost decision support to validate that these new staffing models make sense.
• Provide interfaces or maybe even create web service-based mash-up applications to support these new processes.
• Include these alternative providers in enterprise scheduling systems (or create and possibly host enterprise scheduling systems for our organization and our partners)

3. There will be unprecedented demand for personalization in consumer web sites provided by both providers and payers, dare I say the re-emergence of the portal. From a provider-centric viewpoint, we will be pushed as technologists to:

• Provide tools that measure and deliver enhanced access (i.e., self-scheduling, virtual, remote or electronic visits).
• Provide tools that measure and track progress towards our desired outcomes as patients (i.e., personal care planning tools, disease management tools). Unfortunately, according to recent findings, patients with chronic conditions are using the web less than those without chronic conditions.
• Provide patient-access to their records.
• Provide the ability for patients to estimate, pay, dispute, and view their bills on-line.
• Remember that all our patients aren’t web savvy, have physical impairments or speak other languages. Some of us will be asked to provide access to these tools via telecommunications technologies ( i.e., voice XML – VXML) and other means that meet the patients’ requirements.

4. There will be unprecedented demand for resources to assist patients move through the complexity of the health care system. Call them care navigators, concierges, or coaches, these resources may be free or they may be paid third parties. We will be pushed as technologists to:

• Provide tools to facilitate the communication between the care navigators and patients. Think internet-enabled call center tools (i.e., instant messaging, intelligent conversation avatars, call distribution and management software, referral management software, message tracking software). Customer relationship management (CRM) software will really come to health care to aid with the navigation, document the patient conversation, and to cross-sell our organization’s and partners’ services.
• b. Provide tools that integrate the documented messages into the computerized patient record when required.
• Provide tools that track and document patient and family preferences for care (i.e., locations close to work and home, preferred providers, preferred treatments, willingness to use alternative medicine and care extenders).
• Provide the knowledgebases mentioned in #1 for these care navigators.

5. There will be unprecedented demand for computerized patient records that support outreach to affiliated physicians and data exchange. Eventually, when consumers wake up and payers listen to the demands of the consumers, some level of standards-based electronic data exchange between providers (think HL7’s Continuity of Care Record – CCR) will be required. Therefore, as technologists, we will be expected to provide computerized patient records for our organizations, our partner physician organizations, and ensure these applications support the CCR.

A change is upon us. There will be no shortage or work or demands for investment – can anyone say job security?

Medsphere, Shreeve Lawsuit Settled

Medsphere will announce this morning that it has settled its lawsuit against founders Scott and Steve Shreeve.

News 10/19/07

From Rogue: “Re: HIMSS. The ‘HIMSS alliance with some kind of emergency response group’ grew out of COMCARE’s participation in a HIMSS work Group on health IT for emergency responders. The Work Group published a white paper a few months back (available on the HIMSS website) outlining the patient data issues confronting emergency responders in emergency and disaster situations.”

From Laurie Strode: “Re: Insight. The McKesson Insight user group conference is underway in Atlanta. I’ve attended this conference several times, but not this year (due to scheduling conflicts). It has usually been a good use of time, excellent educational sessions put on by a wide rage of users ranging from nurses and physicians to analysts and consultants.” Link. Somebody ask a question of the keynote and loudly and clearly reference HIStalk, please. Free PR, you know. Is Charlie McCall there?

From The PACS Designer: “Re: Oracle. As a final post on the Oracle Database 11g software, TPD wanted to leave HIStalk readers the web link that lists the features previously mentioned plus some other nice features of this new software offering.” Link.

From Annie Brackett: “Re: Inga. Someone asked me at a cocktail party recently, out of nowhere, ‘Are you Inga’? EVERYONE knew what they meant. I said not hardly, but was flattered. I thought that Inga would be pleased. She’s now like one of those stars that goes by one name, but everyone knows them … Cher, Madonna , Britney, etc.” Well, now you’ve gone and swelled her head with her newfound anonymous fame. Note her news items below – she’s noticeably saucier than usual. Isn’t she fun? Now she’ll want an entourage.

From Lindsey Wallace: “Re: Sunquest. What happened to their other products?” You must be an old-timer. The new Sunquest has deconstructed itself back to its very early roots, selling only lab-related applications. Pharmacy, radiology, Clinical Events Manager, etc. have all been history for some time. I remember a great writeup in Investor’s Business Daily about CEM — right before they pulled the plug on it. Flexirad used to be pretty good, pharmacy not so much. All on the ash heap of IT history. Just laboratorian stuff now.

John has some good stuff on Google Health (“the vision is gone”), HealthVault (“the cupboards were bare”), and Dossia (“… there is a ton of cynicism regarding what the true motivations are of the employers that are sponsoring Dossia.”) I see that, like me, John’s working the cynicism space. Good reading, although I must point out that, despite John’s indifference to Google’s message, VP Marissa Mayer (who was doing the talking) is not only a Stanford MSCS, but an awarded Stanford programming instructor, and not terribly hard to look at besides. She joined in 1999 as one of the first 20 employees, so I’m sure she’s loaded, too. A pretty, rich, 32-year-old geek … well, life’s just unfair.

Speaking of Google, Q3 numbers just came in: revenue up 57% to $4.23 billion, EPS $3.38 vs. $2.36. Yep, that’s over a billion dollars’ profit in one quarter. The company added over 2,100 employees in the quarter, pushing them up to 16,000.

WebMD wasn’t so lucky. Its shares toileted, down 14%, after the company missed Q3 estimates. More importantly, though, was an announcement that the company had signed a multi-year agreement with Yahoo for seach and advertising. That means no Google takeover, which means no one wants wildly overpriced WBMD stock (PE of 236).

Cerner’s Q3 numbers, also just announced: revenue up 8%, EPS $0.43 vs. $0.33. The value of Neal’s shares: $371 million. Makes me remember that it will be HISsies time soon (The Pie).

And speaking of Cerner, this looks like it might be a video made at Cerner’s bash at HIMSS. Despite entertainment featuring two soul groups missing all but one original member each (who sound good anyway, I noticed), the chick on the right is obviously getting down with her bad self and the one gesticulating at her beer looks a little bit like Marcia Brady.

Ben Williams is named CIO for Catholic Healthcare West, coming over from St. Joseph Health System in Orange, CA. Must have been some good money – he was making $644K at St. Joseph in 2005, according to federal forms. No vows of poverty at the new place, either – the president was paid $4.5 million and almost all the VPs were over $1 million, according to the most recent forms. Actually, I was more eloquent back in February: “Humble servant CEO Lloyd Dean made $5.8 million in compensation and benefits in 2005. Read that again slowly … the guy running a nonprofit hospital group out-earned most publicly traded company CEOs. So much for a vow of poverty. Even their HR VP made $1.9 million. What the hell is that all about? You’re telling me that a Catholic-run hospital group has to pay $1.9 million a year to get someone to run HR? And they’re supposed to be a non-profit? Ridiculous. Excessive. Embarrassing. I’m not out of adjectives, but I’ll stop.”

Listening: new VAST.

My thought while driving to work today: widespread lack of IT success in hospitals may be due to the never-ending threat of healthcare personnel shortages (despite the skills of multi-million dollar HR VPs slaving away). Hospitals have a lot of licensed employees who could work in any number of places, most of whom are expected to use IT systems as part of their jobs. What are the odds that hospitals will strong-arm them into changing their work processes as part of a software implementation? Nobody tells nurses, pharmacists, rad techs, etc. what to do because they’ll just jump ship for a competitor or better job. High-paid executives (see above) aren’t about to lift a bedpan, so it’s better to tread lightly when it comes to imposing order. And without that, IT will surely fail. IT is the only industry I can think of where the most highly educated, mission critical, short supply professionals are the ones expected to tickle the computer ivories. I’m not sure I disagree with Reid Conant’s ‘scribe’ model of letting somebody else do the typing. At least with expendable staff you’d have a shot at repeatable processes.

If you want to play around with a mashup tool for non-geeks, Microsoft just release Popfly to beta. Do something interesting with it and let me know.

I haven’t done a poll for a long time, so I figured it was time. To your right: do you keep a PHR?

I’m hearing that Kaiser Permanente has laid off some IT folks at Pleasanton. Feel free to let me know using the anonymous Rumor Report to your right (I’m fanatical about keeping sources anonymous). Layoffs are their business, but the interest, of course, is whether they’re clearing the decks for outsourcing.

William Osler Health Centre in Toronto will implement SolComHealth e-HIM software from SolCom, integrating it with the hospital’s MedSeek portal and Meditech clinical system. I noticed a new SolCom web design while I was cruising, too.

Patient flow system vendor Premise held its three-day user group meeting last week in Mystic, Connecticut.

Even CNET weighs in on Medsphere’s lawsuit against its founders. “Still, customer wins like these would be all the sweeter if the company’s board could come to a peaceful resolution with its founders, Scott and Steve Shreeve. There is blame on both sides, but nothing that justifies a $50 million lawsuit against two entrepreneurs who created what the board manages today. It’s time to resolve the past.” I have never seen a company blacken its own eye so stubbornly and intently, just as it was trying to bootstrap up out of obscurity. That and its “we’re open source, but only if you don’t look too closely” waffling aren’t winning it any friends (or customers, most likely). Soothe the egos, fire the lawyers, make a decision whether you really want to be open source or not, and sell some damn software. We all want to like you, so don’t make it so hard for us. That’s Mr. HIStalk’s free management consultation.

British hospitals, stung by poor financial reviews by NHS, blame software that lengthened patient wait times and prevented cancer patients from being seen promptly. The software was not named, but I believe it may have contributed not only to their delays, but to someone’s $371 million fortoona.

E-mail me.

Inga’s Update

Some of my postings have not made the last couple of HIStalk issues. I am prone to paranoia attacks and initially thought Mr. H was censoring me. Turns out my email was not working (somehow I felt better knowing that it was Yahoo censoring me.) I am happily back online, freeing my energy to be paranoid about other things.

Speaking of paranoia, I think the Greenway folks may have some issues thinking folks don’t take them seriously enough. Greenway releases an announcement that it has “further established itself as a leader in the healthcare information technology (HIT) industry with its latest testimony before the U.S. House of Representatives Committee on Science and Technology.” Greenway’s vice president of marketing and governmental affairs, Justin Barnes, testified last month, along with execs from HCA, AIHMA, and GE, plus a Yale School of Medicine physician/professor.

dbMotion executive Ilan Freedman makes some interesting comparisons between the French HIE initiatives compared to what is going on in the US. I told Mr. H I would be willing to visit France to assess the situation and report back to HIStalk readers. Hmm … that must have been one of the many lost emails because he never responded back.

Re: Epic photos. Someone tell me what the big chicken is all about. I found it a bit creepy.

Only a blessing from the Vatican stands in the way of a merger between UPMC and Catholic-run Mercy Hospital of Pittsburgh. The FTC just approved the deal, as did the PA Attorney General.

Medseek announces new software agreements and consulting projects with 13 hospital systems.

Nuance makes yet another acquisition – the 10th this year, by my count. Guess that is one way to grow your business. Vocada, a provider of critical test result management solutions, is the Nuance’s latest purchase.

Medsphere contracts with another community hospital for its open source-based EHR systems and services. Century City Doctors Hospital in Los Angeles will implement OpenVista EHR at its 120-bed acute care facility.

e-MDs announces a new president, Dr. Michael Stearns. Founder Dr. David Winn will stay on as CEO and chairman of the board. One thing I admire about e-MDs is its commitment to having numerous clinicians on staff. That is not to say that Dr. Stearns, a neurologist, will necessarily make a great president, but I am sure he understands the needs of physicians.

Finally, at least one person acknowledges they agree with me, at least in part, that Microsoft’s HealthVault has some merit. Dr. Douglas Krell sent this note: “I’d like to agree in part, with your appraisal of Microsoft’s HealthVault PHR. I also agree with Dr. Singh that in the beginning, many of the PHR users may be likely to be the worried well, those with real chronic illness, and the Quicken users. But from the physicians’ point of view, I believe that it will be our job to educate and encourage people to make use of these systems to track and interpret their own health data.  We’ve always found that people who actively participate in their own care will be healthier. We need to support those efforts.  It will help us to practice and advise patients more efficiently.  We ARE paid for using these systems to the degree that the more patients we see, the more data we can review and process, the greater our productivity.  Ultimately the better patient care we’ll be able to provide.  Some people will ignore our advice but nevertheless, we should be advocating the adoption of this bit of information technology.”

Is it me, or are all the harshest PHR critics those in the HIT space? Is it because deep down we still want to be the ones to hold the keys to the patients’ records? Do we consider the products too immature to be useful? Do we not trust patients with this information? I remember in the early 80’s when ATMs first became available, you could only use your own bank’s ATM since they weren’t connected. Now you can access your money from any ATM in the world. The point is we have to start somewhere and I think we need more leadership from healthcare providers and HIT to move PRH adoption forward. Otherwise, then years from now, healthcare will be the only industry that still uses fax machines.

I suppose if you use a name like hatchet_guy one shouldn’t expect a lot of feel-good postings. Earlier this week HG commented on the vendor conference mentioned last week and suggested the vendor had a number of problems. I talked to one of the customers mentioned and was told the report was “definitely not accurate” and any issues they had were “temporary” (the individual suggested the posting was so off that it wasn’t worth discussing).

The Hughston Clinic selects athenaClinicals for its nine orthopedic locations throughout Georgia and Alabama. The clinic was already utilizing athenahealth’s billing and PM services. I could be wrong, but I think this is the first EMR client that athenahealth has announced this year.

E-mail Inga (new address because Yahoo Mail eats my messages).

News 10/17/07

From G-Ray: “Re: RHIOs. I was wondering if your readers have any real information on the differences (if any) between HIEs and RHIOs.”

From Miles J. Bennell: “Re: Epic’s campus. I thought you would find these interesting. A client visiting Epic’s campus and took these pictures. Nice looking campus, although I really question their taste in art (see the very large chicken picture).” Link. Definitely cow-tipping country. Like Microsoft’s relocating intentionally to the dreary Northwest to keep the non-work distractions down, the location is perfect for getting fun-loving kids to work too many hours. Like in My Cousin Vinny, “I bet the Chinese food in this town is terrible.”

From Martin Jensen: “Re: HealthVault. While I was away at a conference last week, my partner took it as an opportunity to learn animation. He posted his first cartoon on our new HITCHtv.net website. I think you’ll enjoy it. Check out ‘HealthFault from Microsoft.'” Link. Those Healthcare IT Transition Group folks (Michael and Marty) are funny and smart. I haven’t figured out exactly how their business model works, but it’s fun.

From John Harris: “Re: MSFT. Even Harvard experts think MSFT can sovle the HIT ‘problem’. I did post a link for him back to your blog as recommended reading from an expert on the industry :-)” Link. The Harvard Business Online guy asks the question, “Is Microsoft’s approach on target or do you favor a government-led solution?” Do we only get two choices?

Listening: I was premature in calling Ziggy Stardust the best album ever. I’m now convinced it’s Forever Changes, circa 1967, by Love. Remarkably fresh and brilliant from the tragic, late Arthur Lee and bandmates. I’ve played it constantly for two days.

Scott Shreeve evaluates doctor social networking site Sermo: “Knowledge Prostitution Enabling Aggregated Voyeurism: Is This a Business Model?” Sermo is allowing drug companies to buy their way into the site to influence its doctor members. It’s like Internet porn with (clothed) docs being watched with creepy intensity by salivating drug companies. Big Pharma 2.0.

My newsletter editorial going out tomorrow: “Where Good Products Go to Die: The Elephant’s Graveyard of Conglomerate-Acquired Products.” Finish this sentence: “Base on that title, surely company being referred to is ____”.

EHRConsultant is offering free educational videos on the use of speech recognition software and EHRs, divided by vendor and specialty.

Cerner’s user conference drew 6,700 attendees to Kansas City last week.

Michael Stearns is promoted to president of e-MDs.

Noteworthy Medical Systems names former Eclipsys CEO Paul Ruflin as its new president and COO.

Speaking of Eclipsys, the company is bailing on Boca and moving its headquarters to Atlanta. I guess the traffic wasn’t bad enough there.

Mediware will buy Integrated Marketing Solutions, which sells software for blood donation centers.

Picis announces the release of CareSuite Extelligence Anesthesia 3.0, its anesthesia care business analytics system. The OR version is coming soon.

HIMSS ties the knot with some kind of emergency medical response advocacy group. Roger, Rampart 1.

Here’s a Misys press release about EMRs that contains no news. Maybe that’s why it’s running only on some German stock site.

Microsoft gets further into Cisco’s unified communications business.

The medical division of Philips turns in a disappointing Q3, blaming US regulatory changes for imaging systems.

InterSystems gets a big Cache’ deal with the VA.

Reminders: there are two signups to your right, the first one for e-mail updates when I write something new here, the second for the Brev+IT weekly newsletter (latest issue here, although folks on the list got it Sunday). The Search box to your right will dig through 4+ years of HIStalk to find a company, product, or person that might interest you. E-mail me if you want sponsor information, have interesting news or rumors, or have some other reason to make contact (I read them all).

HIStalk Interviews Robert Seliger, CEO and Co-Founder of Sentillion

Photo: Health Management Technology

Security and privacy in healthcare are obviously hot topics. So, when Sentillion decided to sponsor HIStalk a few weeks ago, I pressed my luck and asked for an interview with CEO and co-founder Rob Seliger. I knew the company was refocusing a bit and also introducing a new single sign-on application called expreSSO, so I offered as bait the chance to talk about that. When I got on the phone with Rob, he said he’d be happy to talk about anything and that we didn’t have to pitch product. Good answer.

When I hear either “single sign-on” or “CCOW”, I think of Sentillion first because they’ve been doing it for a long time. They’ve introduced some new products I wasn’t fully aware of, including the vThere virtualized client for remote access.

Thanks to Rob for the chat.

Tell me about Sentillion and how you came to create it.

Sentillion was founded in 1998, spun it out of the former HP medical products group. I have the simplest resume on the planet – paper route, HP for 18½ years, then Sentillion. [laughs] I was working on technology that integrated applications not on the back end, like databases and integration engines, but on the front end of care, looking at the user experience of the caregiver, whether using applications from the same or different vendors.

We determined that our technology would serve better as a glue, run as a neutral company. We built a business case, they agreed. We spun the IP out with myself and my co-founder in 1998. We did three rounds of venture capital, the last one in 2001, and have been growing the company every since.

We moved from general integration to specific applications used in identity and access management. What we’ve been able to do is create a whole suite of products that address identity and access management needs for healthcare and, specifically, hospitals.

We sell to provider healthcare organizations. We’re unique in that way. Our competitors sell to finance and banking and retail customers. We said that healthcare has special needs, workflows, idiosyncrasies, and constraints. We wanted to create technology that was purpose-built for healthcare. Fast forward and we have hundreds of thousands of caregivers in hundreds of hospitals in the US, Canada, UK.

Healthcare security, like IT in general, seems to fall well behind that of most other industries, with lack of consistent authentication rules across applications, applications that don’t support LDAP or other centrally managed security, and heavy help desk use for password resets. Is it getting better?

It is getting better, but slowly. There are reasons why stronger security technologies have not been broadly adopted in healthcare. The main reason is that they get in the way of delivering healthcare. I’m not a physician or nurse, but I have a tremendous respect of what those people do for a living, taking care of people as their number one job. Navigating security isn’t what they’re paid to do. Our customer base is some of the smartest, most highly trained people on the planet and they’re adept at finding workarounds to impediments to delivering care, including security.

Part of our process is leveraging the years of experience we have in the care business. How many other security companies can you name that have a chief medical officer? We hired Dr. Jonathan Leviss as our Chief Medical Officer because he had a passion to eliminate the obstacles between caregivers and the productive use of computers.

You’ve heard of the last mile problem, like with DSL, where you can’t get connected if you’re too far from the telephone switch. I refer to our situation as the last inch problem, that inch that’s between the caregivers’ fingertips and the keyboard they don’t use. We provide security solutions that make them more productive instead of less, while instilling better security practices across the organization.

People often say that healthcare is slow to adopt technology, yet you can look at the amazing equipment from imaging systems to robotic surgery that is used. I don’t see a fear of technology in healthcare, just an avoidance of technology that’s an impediment to healthcare delivery. Vendors often miss that. We work really hard to get that right.

What security priorities would you recommend to a hospital CIO?

My favorite thing to do if I’m allowed is to take a walk, particularly in care areas, and watch what people are doing, who they are, where the computers are, what they’re showing, and whether they’re attended or unattended.

UPMC implemented our solution years ago. They started deployment in the ICU. I was with an entourage of UPMC executives and I drifted back from the tour group because they were headed to a workstation that someone was using with single sign-on and single patient selection. I stood back and marveled at all the workstations that were not in use, but were locked. I asked UPMC when the last time was that all those workstations with no one around were actually locked. [laughs]

It’s kind of like the broken window theory of why neighborhoods go downhill. Good security isn’t just the things you do on your network with firewalls and antivirus software. It also has to do with what people can see. Show them that their information is being safeguarded and protected. How would someone feel being wheeled down the hall and seeing other people’s information on display? It could be their information as well. You must show personnel and patients that they’re doing the right thing.

You testified before Congress after the VA’s security breach. How would you grade their progress since?

The hearings were for the right intentions but for the wrong reasons. The breach that occurred with the theft of that laptop was benign. The information was not clinical and the thief who stole it didn’t know it was there. At the end of the day, it was a non-event. They didn’t get Congress to the point of understanding how to practice good security.

The VA has the same challenges as non-VA – security vs. usability, however people who work for the VA can be told what to do, which isn’t always true of community physicians in hospitals. The VA has its act together as well as anyone else. They’re continuing to make investments in practical security practices. They’re extending a pilot we did for deployment of single sign-on, which is the first step in a powerful direction for them.

The participation in that hearing was fascinating for me. It was literally like being in a TV show. Members of Congress were in seats elevated maybe 10 or 12 feet in the air, looking down at myself and my VA colleagues at a table. Each member of Congress took the opportunity to express a passionate opinion, not all of which were germane to the conversation at hand. Despite the hyperbole, they actually listened to what I said and what the VA said. They asked good questions. It was a remarkable discourse.

The hearings were well after 9/11, yet the halls of Congress, with minimal screening, are still very open to the public. It was a wonderfully reassuring about our way of life. It was wide open to people who wanted to come and listen and participate and not be overly encumbered with security.

I’ve done so much public speaking that I’m rarely nervous, but I was nervous. I would not want to be there for a serious transgression or offense.

If I looked at your laptop right now, what security measures would I find?

You’d find our product, Vergence, which is single sign-on and a bunch of other things. Virtually everybody here uses it. What do I like about it the best? I don’t have to remember my passwords for the system that approves expense reports, Webex, salesforce.com … the list goes on and on. What I like best is the sheer convenience factor. The screensaver periodically locks my workstation after about 15 minutes of unattended use. That happens whether I’m using it at home or in the office. We all use high quality passwords, mnemonics based on pass phrases, based on an elaborate sentence I can remember and choose some letters from it to make my password.

Unless you’re sitting in front of it, you wouldn’t see the display because of a 3M privacy protection screen. I was working on board financials on an airplane flight several years ago when the woman next to me leaned over, almost into my seat, and said, “You know how to use a spreadsheet.” I thought, “How long has she been watching me work on board financials?” Anybody who’s a road warrior in the company can have a privacy shield.

Security and privacy get confused. The woman looking over my shoulder wasn’t trying to hack our systems, but she was breaching our privacy as a company by looking at sensitive information. Both security and privacy need proper protection. The recent George Clooney story suggests that the concern is well founded that the biggest data access concern that healthcare organizations should have is what happens within their four walls. Too bad Palisades Medical Center isn’t a Sentillion customer, as this is not a good way to get one’s hospital in the news.

Are you happy with the progress that healthcare software vendors have made in making their products CCOW compliant for improving the user experience?

Interesting question. The general answer is no. We’ve put our heart and soul into the CCOW standard going back to the HP days. Standards in healthcare still have a fickle existence when it comes to vendors adopting standards and applying them thoughtfully and properly to their products and with the same interest as something that is purely proprietary.

Much of the venture capital we raised in the early days was spent giving market visibility to the CCOW standard. That helped to a point, but there are vendors to this day who have not implemented the standard or have done so in an incomplete way just to check off that they’ve done it, or done it in an elitist way, interpreting it in a way that’s good for their business interests but not as useful to the customer as a full implementation.

Often a customer will say to us, “You’re Sentillion, can’t you get Vendor X to do it correctly?” I keep looking for that sheriff’s shield or subpoena power to tell vendors what to do. [laughs] We’re just another vendor.

Our answer was that so much of what was conceived by us and others in the standard is extremely powerful, but if vendors won’t implement it timely or correctly, we need another way. We developed a technology called bridging that allows achieving the standard in a way that’s not invasive to the application.

The A-Ha was that the part of the application we can see and rely on is the user interface, as opposed to trying to inspect the application at a code level and hoping for an undocumented API or secret hook that we could latch on to. The user interface is tangible. Because that translates into a series of calls to the underlying OS, we created programs to watch for those calls. We can watch an application as the user is using it and see that they selected a patient. We can get that and send it to other parts of the application to automate patient selection, but without having the CCOW standards.

I read something where someone said that CCOW is a great standard, but that Sentillion controls it. Boy, did that rile me. I’ve been doing this for over 15 years, originally for non-CCOW work. There are very specific rules of engagement for a standards open development process, from NIST, a standard for being a standard, how you vote, how you achieve a quorum, etc. For an open standard, when you have a final ballot, people can vote Yes, No, or Abstain. You throw out the Abstain votes and 90% of what’s left has to be Yes for the standard to be valid. Imagine trying to get that level of agreement in your own family. [laughs] It’s a tough hurdle with lots of opinions, lot of eyeballs before a ballot passes. There’s no way any one organization can control a standard. They can be a blocker if they have enough votes, but they can’t force something to happen.

If there’s a secret to what we’ve done, it’s two things: show up to the meetings and document them. [laughs] I like to write and most people don’t, so often it is myself or others who volunteer to document the meetings, but that doesn’t mean we’ve done anything more than spending evenings and weekends to pull documents together for the greater good. The idea that an individual or organization can control a standard is unfounded.

When I Google Sentillion, I get ads for ComputerProx and Encentuate. What is the Sentillion value proposition over these and other competitors like Carefx?

The companies we’re most likely to compete with head to head are more often companies like Novell or Computer Associates, We’ll also see Imprivata. We don’t see a lot of some of the other companies that come up with the ad hits, even though they’ve latched onto the keywords. Across the board, for all our competitors, there are really three salient points.

First is the healthcare focus. A CA or Novell, while they have sales and marketing teams that cater to healthcare, have products that are generic that are supposed to work in 9 to 5 office environments and not necessarily healthcare.

Second, we believe strongly that we provide a fabric or glue. The last thing we want our customers to have to do is glue our glue. If we show up and say, “We have one piece of the puzzle and you’ll have to work with these other vendors”, that’s not particularly satisfying. That’s why we’ve invested heavily in developing our own products. All our products were developed by Sentillion so our customers would have a single vendor, a single number to call. Every one of our competitors requires multiple partners to do what we do as a single vendor.

Third is the incredible track record we have in getting customers live and keeping them live. We have hundreds of hospitals and hundreds of thousands of users. We monitor uptime across all customers and report to our board like it was financial information. Five nines. Who’s doing that for a security apparatus like we provide?

I hope you don’t think it’s bravado, it’s just pride. There are still hospitals using monitors that I wrote firmware for, like the HP Clover. I still feel pride when I walk by them in a hospital and know that patients are being cared for with something I wrote.

Why is desktop virtualization important?

Going back to this sense of responsibility to solve problems, for years our customers were asking us to help with people who are not physically in their facility, like community docs or docs working at home. We told them we could help to a point, but they’d have to build a portal or provide remote emulation like Terminal Server or Citrix, which requires an investment in servers and expertise. That’s an OK answer, but not satisfying for customers.

We were developing improvements to our internal testing apparatus. We do massive scalability tests to test response time and failure factors and failover. We were experimenting with the virtualizing of clients, not servers. 99% of what people are doing is on servers, putting multiple virtual servers on one physical server. We thought, “With a bit more work, we could provide a virtualized client to our customers.” That was the birth of our vThere product.

Take the clinical workstation with whatever applications, OS, service packs, etc. for people who are physically in your enterprise. You can make exactly that same environment available to people outside your organization. It’s transparent, no particular software package or OS, or even preventatives or antivirus. You need a host PC of a reasonably contemporary vintage running a reasonably contemporary version of Windows. That’s it.

Fire up Windows and you get a completely virtualized version of the clinical workstation running on the host using the host’s memory and CPU, but no other aspect of the host software, If you use a VPN, we use that. The user clicks on an icon, it runs in a window and looks exactly like the application in a hospital. They provide their logon credentials and everything is identical. Radiologists can manipulate their images exactly like in the office without the remote delays. There’s no training involved, no new portal, and no additional expenses for standing up servers to host WTS or Citrix. It’s all running on native client hardware.

We introduced vThere in the middle of 2006. Use ranges from physician access to their full cadre of clinical applications to medical coders who work at home, who have increasing clout because they stand between the hospital and reimbursement. Hospitals are increasingly willing to accommodate a work-life balance for coders. Customers are doing that with IT, too, allowing them to work from home two or three days a week. How can you provide with them their usual applications? Our vThere product is a practical, elegant, and cost-effective solution.

Proximity-based security and biometrics always seemed ideal for healthcare. Are they, and how well are they selling?

We have extensive implementations of proximity and biometrics, primarily in the US. Less so in Canada and in the UK, which has a different model where NHS has mandated the use of smart cards. The combination of active proximity and biometrics is very powerful. You can achieve touchless logon. You walk up to a workstation, your identity is provided to an active proximity device, and you are then authenticated by fingerprint. With Vergence, our flagship product, we can not only log you on, but automatically launch your applications based on your role, and then single sign you onto those applications. The first thing you need to do is select a patient – we can’t read minds yet. [laughs] It’s very powerful. Customers are using the technologies separately as well.

We introduced in the latest version of Vergence a variation on the strong authentication theme using passive proximity devices and an Enterprise Grace Period. Most healthcare environments are reasonably physically secure. You can have flexibility in how you apply authentication to users during the day. The user, at the beginning of their grace period, swipes a proximity card, authenticates by password, and does their business. The next time they need to log on, during the grace period defined by the organization, they only need to swipe their smart card. Possession of the smart card within the grace period tells us it’s that user. Those seven or eight character strokes done 50 to 100 per day times add up. It allows organizations to find the right balance between strong authentication and caregiver convenience.

How does expreSSO change the single sign-on equation for healthcare customers and for Sentillion?

The biggest challenge that customers have with anybody’s single sign-on always centers around connecting with the application. Often, a vendor walks into a sales situation, tries to impress on the customer how easy their tools make it, and shows a live demo. They’ve thought through the applications to impress how easy it is. For more complicated applications, or those developed in-house with less optimal programming, what seems so easy in the sales call is much harder.

We’ve taken everything we’ve learned to make it easier to deploy. The next generation of tooling accompanies expreSSO. A wizard allows organizations to create incredibly sophisticated connectors without having to write code. If you think about a process of creating a connector for signing on and off and dealing with other sign-on related events, you’re navigating through a series of screens and either inputting information on behalf of the users or accepting information like a password expiration message. The trick is to satisfy the application by putting in the right information at the right time while responding to the information needed.

We looked at metaphors that would be easy for people to understand. We decided to use editing a movie. Movies have frames, they flow in a sequence, and you can insert special affects. We take a movie metaphor and apply it to the process of having a user generate a connector to a target application. We show screens in the order they want them to appear and define inputs based on visual controls that they point and click through — for a logon, logoff, or password expiration message, each representing the application as it appears at a certain point in time.

Anybody that’s used iMovie or Microsoft’s movie maker would instantly get how the expreSSO wizard makes connectors for applications. My wife recently edited videos of my son, who’s a competitive fencer. Colleges wanted 15 minutes of video. My wife went through hours of movies, having a great time with iMovie creating effects. She’s not a movie director, and had never used iMovie before, but she was still able to use a tool to do very powerful things.r That’s what expreSSO is all about.

The press release mentions cost savings.

Vergence does an awfully lot more than single sign-on – patient selection, auditing, and role-based access. Vergence is really a platform for creating a complete clinical workstation. It’s always been that, but in the early days, it was too broad for people to understand that, so we positioned it as a single sign-on solution. It’s like saying a car is an air conditioner when it’s more than that, like an entertainment system and transportation.

expreSSO does one thing really well and cost effectively – signing on and signing off. Customers increasingly want to focus on that to start and that’s what expreSSO is meant to solve really, really, well. When they’re ready for a more comprehensive solution, they can upgrade to Vergence.

You’ve had some recent organizational changes, I’ve heard. What’s going on at Sentillion?

We made some changes back in June that were mainly centered around refocusing the company on healthcare. We had started a process with vThere in broadening our footprint beyond healthcare in a thoughtful way. We created a business unit inside of Sentillion to look at opportunities outside of healthcare so the bulk of the company could stick with healthcare.

It’s difficult for a $30 million company to do as many things as we were trying to do. We were diversifying into the UK, bringing vThere and expreSSO to market, and trying to establish a foothold for vThere outside of healthcare. It was one vector too many. I decided we needed to reconsider expanding outside of healthcare, or at least let it be opportunistic and let companies find us. We had hired people without the healthcare background because we didn’t need that.

We’ve just come off a terrific Q3, the first full quarter since the change. We signed six new customers and sold a bunch of products to existing customers. It was a good thing to do and we did it thoughtfully for our customers and employees.

What do you like most and least about being a CEO?

I thought I would miss writing code. My expertise is in distributed, object-oriented programming. How’s that for a mouthful? [laughs] I really don’t miss it. I find what I really enjoy is the challenge of doing things that others haven’t done before.

People often ask me about what I do other than work. I have a car that I’ve been building for years. I drag race it. It’s a combination of parts that have never been put together, which means I make a lot of mistakes. I fine tune my problem solving skills and persistence. The thing I love most is to see what others here are able to accomplish that I have nothing to do with. It’s intensely satisfying. It happens following ethical principles that we care about and a corporate style that I care about, but I had nothing to do with it.

What I like least is the set of arcane accounting rules that govern software revenue recognition. It’s a set of principles defined by accounting boards that software companies need to follow to book revenue on an annual or quarterly basis. The rules are complex, but accounting rules don’t have that foundation of reason. It’s kind of like laws that evolved over the years. You can spend an inordinate amount of time interpreting the rules so you do the right thing. I’m not always sure that time is effective for the business or customers, other than you want to do the right thing.

Who do you admire in the industry?

The people that I admire most are in the new generation of CIOs, probably in their late 30s or early 40s, who grew up with information technology instead of having it happen around them. They have business savvy as well. The combination of a comfort with IT and business savvy are impressive.

Mark Hopkins at UPMC is one such person. Steve Hess of Christiana Care, Praveen Chophra at Childrens Healthcare of Atlanta, Allana Cummings of Children’s Omaha, and Marianne James of Children’s Cincinnati. All of these are examples of healthcare CIOs who have a comfort with technology and business acumen. They are putting it to formidable use in their organizations.

I gave a lecture at HIMSS about the healthcare tipping point, referencing Malcolm Gladwell’s book. One of the required ingredients is people like this to make it happen. If healthcare IT becomes truly pervasive in the next five years, it will be because of people like this.

Thanks for sponsoring HIStalk, by the way.

What was most fun about sponsoring your blog is that we all reading it already. It was a Homer Simpson Doh! moment. The best endorsement is that we didn’t just hear about it and decided to sponsor. Just like we use our product, we were already reading your blog.

Monday Morning Update 10/15/07

From CraigD: “Re: Sunquest. As of 10/11/07, Misys Healthcare is now known as Sunquest again. However, they still have the same management that is driving them into the ground. The previous management was a lot better.” The “new Sunquest” is unveiled, as Sunquest Information Systems re-forms as a privately held corporation by Vista Equity Partners, the new private equity owners of the former Misys Healthcare lineup of lab, radiology, and pharmacy systems. The new/old name is a great move that I’ve advocated here previously, writing off the sorry Misys chapter of the company’s history as an unfortunate decision by all involved. Richard Atkin has been named president and CEO, a move I don’t get since he ran the division under Misys. I would have expected (and advocated) new management all around, starting at the top, but I understand the need to keep the customers from getting anxious at the prospect of wholesale change right out of the gate.

From Lauren Graham: “Re: CHIME conference in San Antonio last week. It was my first time attending. I have been impressed at my colleagues’ commitment to their careers and their willingness to share best practices. I had the opportunity to meet Judy Faulkner of Epic and found her unexpectedly down to earth and approachable. I was surprised that there were no vendor exhibits, but having the vendors around at the social functions and meetings was perhaps better because it felt more personable and less like a sales job. There was a lot of chatter about aging baby boomers, with a speaker recommending that we hold on to our older workers because there aren’t as many younger workers to take their places (the youngsters tend to go from job to job and like to be self-employed). A lot of hospitals and health care systems are talking about relaxed Stark laws, but many just don’t know where to start. A number of us are unsure if we should adopt a standard solution or promote multiple alternatives and if we should provide the hosting. Also, no one has a perfect solution for handling physicians who already have EMRs.”

From Steve Forbes: “Re: NextGen. NextGen/Quality Systems all the way up to #5 on Forbes Best Small Businesses list. Look out, Under Armour!” Link. Very nice. I see Advisory Board came in at #46.

From The PACS Designer: “Re: PHRs. Since a PHR is your diary of your health conditions and other important health information such as insurance coverage, allergies, inoculations, and other histories of treatment, it is vital that the record be protected from unauthorized viewers. PHR access will be in the total control of the creator of that record, just like an online bank account is controlled by the depositors. When you want a healthcare provider to know your history, you will enter a ‘Linking ID’ provided by the treatment professional into your PHR for a given time period so you can obtain quality healthcare services. Also, if you have a healthcare advocate, you would want them to have an ID to access your health record. Since you completely control the input of information, you are liable for any discrepancies should something adverse happen to you from not informing the care provider beforehand.”

From hatchet_guy: “Re: the vendor conference you mentioned. Call UPMC and ask about the 2007 code release, where the word is that lawyers are involved. Call Clarian – if ‘Lights On’ was so great or Release 2007 so strong, why did they turn the product off? Call Boston Kid’s ask why they stopped their project. The reason for the ‘strong commitment’ to the 2007 code release is they F’ed it up so bad that they a) are afraid to release anything else, and b) have so many fixes to apply to the code level that it is now a student body right to even get things fixed. It was the right decision, but not for the reasons they are spinning.” All unverified, I add cautiously. I’ve had no reports from any of the hospitals mentioned (despite asking). Since some hospitals are doing OK (or at least say they are), it can’t be all bad. Inga will happily chat with any customer willing to provide a first-person report.

From MSFT Doubter: “Re: Healthvault. Interesting note in the Business Week article about HealthVault and Azyxxi. ‘Peter Neupert, head of head of Microsoft’s Health Solutions Group, figures he can build a business that generates ‘a billion-plus’ in revenue from HealthVault as well as another business that sells software to hospitals.’ Wouldn’t $1 billion make them almost as big as Cerner?” Link. Other than that quote, the article is pretty much a waste (who says ‘file server’ when talking about the Internet, or believes that hospitals are likely to send data to HealthVault?) Cerner is at about $1.5 billion in revenue, so that would make HealthVault a little smaller business if Neupert’s guess is good. I notice all the talk is about ad revenue, which is pretty much what I’ve said here: HealthVault is a Microsoft attempt to get into the sexy ad game like Google and nothing more. This is not a Gates Foundation project to benefit humanity, other than that subset of it holding MSFT shares.

From Steve Stifler: “Re: Google-WebMD. I spoke to a high level source at each firm who would be ‘people familiar with the situation’ if they were being quoted on the record, which they are not. I am told with 100% certainty by both parties, independent of each other, that there is no deal and will be none any time soon. It seems that WBMD and GOOG entered into a search partnership many months ago, at which time GOOG did some DD on WBMD and were unimpressed. Unlike MSFT, WBMD has no new, innovative, or interesting technology that can help GOOG. In fact, it’s just a big portal of content from other people and a brand created in the dot com era. My GOOG contact told me that they felt like they could re-create WBMD’s entire offering in a week and that they already get more traffic via health searches than WBMD. GOOG wants someone with innovative technology and they are likely to go the MSFT route – buy it and add to it. There is no ‘killer app’ at WBMD. Also, my GOOG contact noted that. because of the HLTH ownership issue and all the recent WBMD acqusitions, its a financial mess. Its not going to happen, folks.” HLTH stock rocketed up on huge volume Wednesday, but then backed off. Lots of people are ricocheting the rumor back and forth, which started with a bored stock reporter’s fantasy with nothing new since. Still, the rumor has legs and it Google hates to lose to Microsoft. If there’s any truth to it at all, it will be consummated or not based on WebMD’s asking price per set of eyeballs since Google thinks in terms of Web traffic and stickiness for that kind of site.

From p_anon: “Re: RSS feed for comments. Hook a brother up!” Try this for reading comments posted to HIStalk2.

From Pony Boy: “Re: Healthvision. I’m sure you’ve already heard, but Scott Decker left Healthvision on Friday.”

Epic’s Lucy project steals HealthVault’s thunder in a Wisconsin newspaper story. “Epic also is working on a project called Lucy. For patients with more than one main health care provider, such as someone who is seeing a specialist, Lucy will link up the different health care charts, Rana said. A patient who changes doctors and moves to a non-Epic system will be able to keep his or her electronic medical records and pass them along … Epic’s Lucy will also offer a voluntary health diary that’s open to anyone, even non-Epic users. But the big difference is that it will link back to a health care provider who’s using an Epic system, Rana said. Microsoft’s HealthVault doesn’t do that, at least for now, he said.” Epic is already ahead of everyone else with MyChart, a patient PHR window into information stored on Epic’s systems (which, given Epic’s customer base of the largest IDNs and medical centers, already gives it a huge advantage). Given Epic’s hospital and ambulatory system focus, along with the company’s clinical capabilities, it’s likely that its PHR-related products will be far better than those from Microsoft and Google. For everybody but Epic, the metric is ad sales volume, not patient outcomes.

Sage fires its North American execs. CEO Ron Verni and CFO Jim Eckstaedt are shown the door because the British accounting software company hasn’t sufficiently cracked the US market (sound familiar?) Investors responded by enthusiastically dumping shares.

Is another RHIO/HIE type vendor putting itself on the block? I’m hearing faint rumblings. I don’t know the company, but the supposed acquirer (whose name I do know) is big in physician systems and the deal could supposedly be done within a couple of weeks. If that secret is tearing you up inside, you can always talk to me.

Palisades Medical Centre (NJ) suspends at least 27 employees, including seven nurses, who couldn’t resist peeking at George Clooney’s chart while he was being treated for motorcycle injuries. Clooney was classy, saying he would hope that privacy could be upheld without suspending hospital employees. The 30-day suspension is without pay.

Baird Capital Partners has acquired ED coding and billing vendor MedData and replaced CEO Richard Pugh with a company man.

Cerner’s ProVision imaging workstation gets FDA marketing approval.

Jewish Hospital of Louisville turns its IT department over to Perot in a 10-year deal. A handful of employees will stay with the hospital for strategic planning, another handful who didn’t want to work for Perot were laid off, and the remaining 110 are guaranteed a year before Perot either lays off or transfers an unnamed number of them that have already been deemed excessive.

Bizarre: MyFreeImplants.com has a single focus: “Win a Free Boob Job”, or, in the apparent vernacular used by those providing testimonials, achieving “Hooterville”. The social networking concept is employed (Cleavage 2.0?): women post photos and make themselves available for private contact with “benefactors” who donate to their worthy cause. It’s all noble, you understand: “Please, let us help you to become all that you are capable of. Change your life for the better, one step at a time.” That such a site exists speaks volumes about everything that is both right and wrong in America.

New CCHIT commissioners: Linda Hogan (Pittsburgh Mercy), Rick Ratliff (SureScripts), David Ross (Public Health Informatics Institute).

Aetna CIO Meg McCarthy, once a less lucratively compensated provider-sider (you have to be a middleman to make money in this business), gets profiled.

GE Healthcare’s profits drop slightly in Q3. CEO Jeff Immelt blames the government for exercising fiscal responsibility by capping Medicare imaging payments. Despite that wound-licking, the company manages to scrounge a few pennies together from its $692 million quarterly profit to buy Dynamic Imaging, a vendor of Web-based RIS/PACS.

Health First (FL) will implement the access management suite from SCI Solutions.

E-mail me.

Inga’s Update

First things first. I am pretty sure I would have tried to sneak a peek at George’s records, too. There has to be some sort of HIPAA exemption if the patient is one of the most gorgeous men on earth.

An Allscripts employee sent me a note saying their stock went up, even though the overall market declined. Clearly it was a result of Glen ringing the NASDAQ bell.

And speaking of them, Allscripts announces that 100 physicians in Southern California will begin using their products. The buyer is Lakeside Systems, Inc., one of California’s largest healthcare associations.

HIStalk sponsor Picis announces Abington Memorial Hospital has implemented Picis ED PulseCheck.

Medical transcription provider SPi announces a new Best Shore program that allows clients to choose where their work will be done – the US, offshore, or both. I didn’t see any pricing information on their Web site, but you just know there has to be premium for selecting the US.

E-mail Inga.

News 10/10/07

From Will Weider: “Re: EMR. You mentioned the Marshfield Clinic as a developer of their own EHR. I have blogged about them in the past.” Link.

From Economist: “Re: pricing. I am trying to figure out how pricing for software applications usually works in this industry. There are two issues I am unclear about: Is pricing usually done according to the number of users or in another way? If it is done by users, is it usually done by named/registered users or concurrent/active users? Do vendors offer a set of predefined software packages or do they offer a variety of modules and let you “pick and mix” according to your needs?” I’ve done a lot of contracts and they were almost always based on occupied or licensed beds, although Epic and Cerner started the trend of increasing fees based on volume of lab tests, patient days, etc. (I dislike that a lot because you can’t budget for it and you are paying more for exactly the same product and service, a disincentive to use it more widely). I’ve seen concurrent users listed on occasion, although that’s more common for underlying technologies like database licenses. All vendors I’ve seen offer a long list of applications, for which one can likely negotiate a discount (from the fictional list price) for purchasing multiples of them. The main thing to remember is to look at total cost over an expected life of 7-10 years since implementation services, annual content fees, maintenance fees, and third party licenses quickly eclipse the upfront capital cost.

From Sanka Coffie: “Re: Intel. Intel recently launched a website to help it keep abreast of industry trends. It had used it internally, but decided to open it to the public. My point is, if you click on the Healthcare site, there are no entries. Kind of says it all for leading software technology – zip, nada for healthcare. Just had to share.” Link.

From Cigarettes and Water: “Re: Micromedex. Rumor has it that Thomson Healthcare is looking to sell its Micromedex business unit, which generates approxiately $40 million in earnings on $120 million in revenue. The problem is that it’s not growing significantly and is probably at its most valuable. Thomson continues to organize itself around solutions for preformance management.”

From The Cooler King: “Re: a certain UK practice management company not named Misys. The rumor inside is that the whole company is up for sale this time, but the healthcare division may have a better breakup value to interested parties.”

From Just Asking: “Re: HIT Summit. I am surprised to see your support for HIT Summit. Seems like just another boondoggle for CIOs and vendors at one of the most exclusive hotels around. Sounded like you were going to go?” I’ve been to two conferences like this one and found them worthwhile for executives with broad strategic interests, networking interest, and budget. It’s very much like flying in first class: great for making important contacts in a much more intimate setting than the usual conference, a more relaxing and upscale experience, but not necessarily for everyone. With the HIStalk discount, the registration fee and hotel will run less than $2,000. Not cheap, but not way out of line, plus you could always pick a less expensive hotel. I won’t be there, but at least one reader is going and offered to report back. The speaker lineup is impressive.

From Whitby Bevil Sr.: “Re: WebMD. I heard from a reputable source that Google is in acquisition discussions with WebMD. This would be an interesting counter move to Mr Softie’s HealthVault. It may also explain why Google’s top healthcare person recently left without much explanation.” Wouldn’t surprise me a bit. I’ve heard similar rumblings.

From Josef Grool: “Re: EMRs. Isn’t there a software entrepreneur out there who would fund an X-prize for hospital EMRs, then sell it through a non-profit? The current 12 vendors all have such significant shortcomings that a well-funded team could probably build a much better system without all the baggage. Ambulatory EMR systems are much better than any acute systems.”

Barry Schoenbart, MD, medical director for Reliance Software Systems and an old friend of HIStalk, wrote me about Care Plus Next Generation, the clinical system his company is developing for Henry Ford Health System. It will include a full-featured EMR for both inpatient and outpatient care venues. Modules include EMR/EHR, result delivery, order entry, clinical documentation, physician portal, document imaging and document management, and care coordination and reporting. Community physicians will be able to order labs and rads electronically. User acceptance testing is starting and Ford will go live in May. RelWare will sell the system commercially as RelWare’s OneRecord. Good update.

William Crawford from Children’s Hospital Informatics Program in Boston e-mailed about Dossia, for which CHIP has taken over PHR development. “First, factually: Dossia is neither being developed by, or operated by, the employers. It’s being developed by CHIP, based on the Indivo platform. Indivo is open source and always has been, and it will continue to be so. That’s about as transparent as it gets. Founder company employers have no role in operating the system, either – the only people who will have access to the operational system will be CHIP technical operations staff and selected employees of our hosting partner. Just to make it really clear, further in the article you’ll also see that Colin Evans directly goes on record saying that the employers will never have access to the data. Second, philosophically: I find it very hard to believe that anyone from the Dossia Founders Group would have asked for back door access to employee healthcare data. It doesn’t make sense – the entire purpose of engaging outside partners to create the system was to make absolutely sure employees could trust that nobody would be looking over their shoulders. The goal here is to give millions of employees tools to better navigate the healthcare system and make more informed choices about health and wellness. That’s much, much more valuable than any decision that could be made around a single employee–or any value that could be realized by selling data out the back door. So Dossia won’t be doing either of those things, and CHIP certainly won’t be enabling them to do so. One of the main points of alignment between CHIP and Dossia is that the employers would not have access to the information stored by Dossia. That’s why we call it a Personally Controlled Health Record – we really are letting patients make the decisions about who sees their data. And it’s not an obligatory system, either – nobody has to opt into having a Dossia record.” Thanks for that. While I believe patient privacy is in good hands with CHIP’s development efforts, there will always be that patient suspicion (unfounded or not) that centralizing patient information electronically could be tempting to those who could benefit financially from it. Maybe the result will be that fewer users will sign up, or that the information they record will be incomplete. Reassurance will be important.

My newsletter editorial for Wednesday: “Smoking the CIO-Doctor Peace Pipe: Let Practices Choose Their Own PM/EMR Gift”.

EnovateIT signs a big deal with TriHealth (OH) for 125 wall-mounted articulating arms and 125 point-of-care carts.

Mitem announces Blue Iris eLaborate 8.6, its Web-based hospital orders and results application for physician offices.

TeleTracking announces increases in patient flow software sales and revenue over the past six months.

Seton Family of Hospitals upgrades its emergency messaging system from React Systems.

SAP will buy Business Objects for $6.8 billion, guaranteeing software vendors and customers that Crystal Reports will get even more expensive for producing labels and reports.

North Carolina Healthcare Information and Communications Alliance (NCHICA) gets a HHS contract to develop NHIN interfaces and transaction sets.

E-mail me.

Inga’s Update

Three Georgia nurses are fired for HIPAA violations. Apparently the trio was intrigued by a patient in the SICU who had a knife through his skull. They used their cell phones to take pictures.

Ascension Health, Catholic Health Initiatives (CHI) and Catholic Health East (CHE) have joined together to form CHV II, LP a $200 million VC fund focused on investments in the healthcare industry. This is the second fund venture for Ascension and the first for CHI and CHE. They will target expansion to late stage medical device companies, and healthcare technology and service companies.

Siemens announces that they really do have clients using their EDM and Soarian HIM solutions. If you are going to the AHIMA, you can visit the Siemens booth and talk to some of their real clients. (Did anyone else reading this press release interpret their main message as, “We have clients”? Or maybe I am just turning cynical like Mr. H.)

Set your DVR’s to CNBC! Wednesday morning at 9:30 a.m. ET Allscripts CEO Glen Tullman is presiding over the NASDAQ opening bell.

Eclipsys announces that SingHealth, the largest healthcare provider in Singapore, has selected Sunrise Clinical Manager.


E-mail Inga.

A Report from the Cerner Health Conference

The Cerner Health Conference kicked off Sunday at the Kansas City Convention Center. Don Trigg, Cerner’s chief marketing officer, offered to connect me with some attendees for a report. (I should note that, despite my occasional criticisms of Cerner, Don has always been a straight shooter, has invited me to Cerner events, and offered to connect me with sources there, all in a casual, non-official way, which I appreciate).

My guests for this live update were Helen Thompson, CIO of Heartland Health of St. Joseph, MO; Reid Conant, MD, CMIO of Tri-City Emergency Medical Group of Oceanside, CA; and Stephanie Mills, MD, CMIO and CIO of Franciscan Missionaries of Our Lady Health System of Baton Rouge, LA. I’m sure they were ready to relax after a long day of conference education, so I appreciate their voluntarily taking time to speak with me.

What’s your impression of the conference so far?

Reid: It’s been very productive sessions so far. I gave two talks today and will be on a panel on Wednesday. I sat in on a few sessions and shared ideas with my colleagues. The setup of the CHC is kind of neat – it’s primarily client-driven educational sessions. The overwhelming majority of sessions are either entirely client-presented or have a panel with Cerner people and other clients. It’s sharing of ideas. It was in Orlando for a few years, now it’s back in Kansas City. It’s a very productive way of sharing ideas among clients. We’re using many of the same applications. You can always learn something from someone else who’s using what you are in a different way.

Helen: The networking that we get from this event, as well as the strategic look at what’s next on the agenda, makes this an extremely valuable conference.

Stephanie: It’s been very interesting to watch healthcare IT over the past several years. I’ve seen us as clinicians become more engaged, more involved, and more committed to developing solutions for quality and patient safety challenges. It’s a group of colleagues with the same experiences, tools and challenges. It’s important to get together in a safe environment and collaborate. It’s amazing what comes out. It breaks down a lot of the barriers.

How would you compare the value you get from attending Cerner’s conference to other conferences like HIMSS?

Helen: We’re just 45 minutes north of Kansas City, so the location factors in. We have an opportunity to do much more focused sharing and learning from one another. HIMSS has such a broad range that it makes it difficult to do this level of collaboration.

Stephanie: It’s practical, with stories from other organizations. Very practically oriented. HIMSS tends to be more theoretical, which is also good. You need both sides of the coin. In the trenches, to know what is or isn’t working.

Reid: Being in Kansas City, there’s been an even larger presence of Cerner associates. That’s done a few things. It’s gotten them more involved and given them a view of what clinical medicine is. I heard from a few of them that that is encouraging to them as they’re working on code. For us, it allows us to give them direct feedback. That’s very important and they seem to listen. I’ve been on an ED solution advisory group for years and they take direct feedback on specific issues. Today in one of my talks, I spoke about using scribes with PowerNote. Cerner has electronic, template-based charting. To augment productivity, we use undergraduate students to assist the physician in creating that document. That electronic record gives them the tool. After this talk, an engineer came up and said, “We liked what you did with that column. It fits with our code.” They want to put it in the product. These guys will listen and the next service pack will often have those kinds of suggestions in them. That reception of ideas is valuable.

Stephanie: Team members were here and some of the Cerner documentation team were dealing with some challenges that’s been difficult to diagnose, working over phone and conference calls and sending log files back and forth. We got in the room, got on the system, and had both teams together. To be able to share those experiences is really valuable, to have direct access to a vendor and share that knowledge and experience and frustration – it really gets folks bought in to finding the solution. We build relations with people, not just a voice over the phone.

Reid: It makes them accountable on a personal level.

Helen: It makes us accountable, too, because we share feedback with them. The success of our organization is tied to the success of this application. It’s very much a two-way learning street. They learn so much from us while we’re down here presenting and we learn from them as the dialog is opened.

Have there been any big announcements or revelations so far?

Reid: This morning, Neal Patterson said something that I felt was impressive. Cerner has taken a stand as an organization and said, “We are going to focus on the current code level.” In this day and age of rushing to get the next release out, they said they’ll focus on 2007 code and put all of the innovation into that code level. They’re going to, for the rest of this decade, ride that code level and make it the best they can, as solid as they can, before moving to a major change to the architecture of the code, incorporating Java and so forth. Thankfully, they recognized that ahead of time. I appreciate that.

Stephanie: We’ve had keynote addresses, discussion about health policy, the future of healthcare, how technology can come to the table in a number of ways. Then, lots of sessions in different areas that focus on a combination of presentations from clients in the trenches and living this, and also some sessions from the Cerner team about what’s going on today in problem solving and development.

Helen: The conference is broken down into a series of tracks to select from. Some are application-specific, some are role-specific. There’s quite a broad range.

You mentioned code levels. Millennium’s Achilles heel for years seemed to be response time, with a rumor that the entire application would have to be scrapped and sent off to India for a rewrite. Was that mentioned and are you seeing performance issues?

Reid: When went live 3 1/2 years ago, we felt some of that. We’ve been remote-hosted since go-live. Some places that tried to do it on their own felt that impact. They had more delays then than now. ED is one of the fastest paced environments. Anything short of sub-second response time won’t cut it and I won’t hesitate to call them for a four-second delay. That’s just not an issue any more. We’re using CPOE with meds and every order I enter is through the system. I can enter 20 to 30 orders on a complex patient in 15 seconds, using order sets and other tools. There are lots of clicks. If response time is not immediate, I feel it and they hear about it. What Cerner highlighted today is the Lights On Network, a Web-based application that allows you to drill down to an institutional and user level on response times. They track some huge number of the most common and most important actions. They track each and every one, so you can literally drill down to Dr. Mitchell if he’s complaining and say, “We saw at 2:55 pm you had one delayed action, but other than that, it’s been sub-second.” You can also pull out by department, not just response times, but how they’re using it, like ignoring alerts.

Helen: We’re a client-hosted solution and Lights On Network user for over a year. We’re very pleased with system performance improvements that Cerner continues to develop from data they get from Lights On.

Stephanie: I agree. We’ve been quick to look for a quick fix for our healthcare woes and sometimes fall prey to technology seduction. We want the magic Band-Aid. At the same time, we’re quick to blame when the magic fix doesn’t solve the problem. You can’t do that in a vacuum. When you look at performance, we have a lot of challenges that can be pointed at a particular vendor or application. We’re maturing as an industry in applying best practices like ITIL. For leaders in healthcare IT, it’s important to have a comprehensive perspective and make sure our organization is optimized to provide quality of care and to apply technology. It’s about people and processes and workflow and not just automating a process.

Helen: We need to think back. When we had a paper record and a very ill patient and the chart got larger, it took longer to filter through that information. The more data we collect, it will be a more constant process to keep sub-second response.

Reid: One real strength of Millennium is integration, like accessing old records. If the patient rolls into the ED by ambulance, with a couple of identifiers I can pull up the record from visits three days or three years ago. The ED course is immediately accessible to the nurse in the ICU. For hospitalists, it’s worth it to get out of bed and get online. They can look at orders and tests.

Stephanie: It really does change the way we pratice completely.

Are you glad the conference moved to Kansas City?

Stephanie: It’s helpful for the reasons we mentioned, access to team members and architects and engineers and folks here behind the scenes that we don’t get to build a face-to-face relationship with. Orlando is a very big conference town and its nice to bring it to Kansas City.

Reid: It’s a busy week, too busy to bring the family to Disney World, so we get much more out of having it here.

Are you planning to check out any particular Cerner products?

Stephanie: We’re an integrated Cerner site using a lot of the solutions. We’re going through a reorganization of Information Services. The next step is to optimize what we have, dialing things back, looking at current state, looking at workflow. The next piece that we already own but haven’t implemented is Power Insight, which has clinical and operational dashboarding.

Helen: We’re optimizing the solutions, also looking at the Care Aware product, leveraging the application to move to a digital environment.

Reid: Care Aware is on the horizon. It was demonstrated this morning at the kickoff. In the ICU setting, where they’ve had antiquated paper flowsheets with graphs four by six feet double sided [laughs] someone goes in there with a pencil and traces the latest vitals on that graph. How antiquated is that? But it was one of the most useful tools. If I go to a code, that’s one the first things I look at. Care Aware is a centralized reporting tool and repository for acute care patients. Many of us were salivating at the demonstration. It uses a larger screen, maybe a 20-inch monitor, with an image of the latest chest X-ray, vitals, etc. It’s highly customizable at the user level. It asists you in decision-making, changes in plan. It appears that it will be an invaluable tool.

Stephanie: It will be great. It’s been fun to see this in development. In Louisiana, we have problems with access to care. We can leverage what we have outside of our walls to create a virtual critical care environment that’s more automated. We’ve been saying, “You have to be able to tell the story and have that snapshot in a comprehensive view.” Our Lady of the Lake has created our version using Cerner tools, but it’s pieces and parts and not quite as seamless. To be able to see that pulled together and configurable is certainly where the future is.

Reid: It takes something like the tracking board in the ED, the FirstNet application. The tracking board is highly customizable, data-rich, and drives processs improvement. It’s a very powerful tool. At a glance, you can see exactly what’s happening with each patient, what’s pending and what’s back. It’s a matter of getting as much data in an organized fashion right there in front of the provider.

What would you say has changed most dramatically about Cerner in the last couple of years?

Stephanie: I’ve seen consistent dedication to partnership, to collaboration from Neal Patterson down, a true interest in what’s going on and how Cerner can impact that. I think it’s authentic, it’s genuine. When the Cerner brass comes to visit your hospital, they’re out there and want to know what’s going on. They’re continuing to march the ball forward in that arena. We need all the help we can get in healthcare, to have companies that are truly committed. We’re all in this together. To feel that we’re able to collaborate with our colleagues and vendor partners in a meaningful fashion and with the patient as our primary responsibility – what more can you ask for? We’re continuing to see clinician involvement on the Cerner side. That’s promising. They’re taking a smart approach to technology, applying it where it makes sense, and not just trying to get the latest whiz-bang out.

Reid: An example of that is the organizational decision to take a step back and not advance to the next code immediately. That’s organizational maturity. There’s always the risk of misperception of what that means. I don’t think it’s a negative indicator. It just shows that, when they roll out the next code, that they want it to be a dramatic step up. Where we already are is phenomenal. Look at the curves on the Lights On Network and graph performance over the last year or two. You can see a very steady and fairly steep drop in response times, now to the point where it’s not an issue.

Monday Morning Update 10/8/07

From The PACS Designer: “Re: Oracle RAT. A new feature of Oracle 11g is Oracle Real Application Testing, or O-RAT. If you need to make frequent changes to your database applications, O-RAT makes it easier to identify and quickly fix any problems that may be occurring in the production system. One nice feature allows you to capture the production section that needs repair and bring back to the testing platform for analysis and testing of the changes you made to fix any problems. Also new in O-RAT is an SQL Analyzer to do more with fixing and improving performance of any SQL executions.” 

From Jake Ryan: “Re: HealthVault. Why anyone thinks our industry should connect patients to doctors before we connect doctors to their own data via other doctors and hospitals constantly blows my mind.” That’s where everyone thinks the money is – consumer advertising. Nobody pays doctors extra for demanding the full set of data that they know is available. Nobody pays insurance companies less if they don’t insist on it. Ads have a simpler revenue model – you make money for showing them or getting people to click on them. Whether that turns out to be beneficial to the clicker or clickee doesn’t matter. Until they stop clicking.

From Samantha Baker: “Re: HealthVault. I couldn’t agree more with your Healthvault comments. What strikes me is that technology companies often don’t understand that people have relationships with physicians, not Web sites.” PHRs are a pipe dream until (a) doctors can get paid for delivering care electronically; (b) access to patient-maintained information from the practice’s EMR is seamless; (c) information can be imported into the EMR to become part of the legal medical record; (d) patients and application vendors get serious about making data collection easy and error-proof; and (e) a firewall is created that keeps insurance companies and employers from digging around patient information to use it against them. I’m not even mentioning privacy concerns since those are obvious. The healthcare model is built around your driving to the doctor’s office, even when your needs could be addressed via electronic means. Parallel: there may be a few people who use TurboTax religously and constantly throughout the year and then make a CPA appointment to review their records at tax time, but not many. Plus, CPAs accept what you give them at face value, while doctors insist on observing it for themselves. Like much of the practice of medicine, you won’t change that unless you change medical education.

PHR counterpoint: the worst that can happen is that no one will use them. Surely they don’t cost much to build for a big company like Google or Microsoft. The search engine alone will more than pay the bills, most likely. These companies aren’t tied to healthcare anyway, so why not take a shot and walk away if it flops? Once the site is built, keeping it running even with few users is easy. Maybe enough of those little old ladies who love going to the doctor will keep PHRs with the same fanaticism as scrapbooking, clicking on enough ads to keep advertisers paying. That’s hardly a healthcare revolution, but then again, that’s not what motivates advertisers or Microsoft. And, the spur in medical device connectivity is a good thing.

From Farmer Ted: “Re: ‘I’ll Have What He’s Having’. With such a major investment and one that has the potential to be significantly disruptive and impact patient safety, can you blame people for the approaches that have been taken in purchasing systems?” Not really, especially since the minefields are many. However, hospitals like to think that continually seeking more information will lead to a better decision. There’s only a dozen or fewer clinical systems vendors out there, so it’s not an infinite universe of possibilities (although the one option they often should choose, i.e. not buying anything, is often given the shortest shrift). If a vendor can produce even one hospital that is achieving great clinical or financial results while using its software, then (a) it’s good enough; or (b) software isn’t a critical factor in that outcome anyway. In fact, I’ll postulate that the search process is of far more value in giving a hospital information about itself than about potential vendors. However, that discovery may lead hospitals to believe that identifying the problem, plus simultaneously looking at systems that claim to solve it, means that the problem is nearly solved. Unfortunately, ain’t so, usually for organizational reasons, not technical ones.

Speaking of HealthVault, Bill Gates has an editorial in the Wall Street Journal. It’s grand and eloquent in scope in its observation of human endeavor and frailty, skillfully masking the message that Microsoft is getting sand kicked in its face by Google and everybody else and needs a new advertising platform. It has the obligatory IOM quotes, healthcare crisis boilerplate, fragmented information examples, etc. Bill claims that HealthVault “will undoubtedly improve the quality of medical care and lower cost.” I’m doubting, so prove me wrong in a research study. Or, why not go at risk for a percentage of the savings instead of charging for ad space?

Last on HealthVault: lots of people hate Microsoft. Blue screen of death. Microsoft Bob. Forced upgrades. Browser security holes. Antitrust issues. Internet tollgate. Assume people buy into PHRs on a big scale. Of all the companies offering PHRs, which one would they trust least with their most personal information? Some Ukrainain hater will have it hacked by this time next week, I suspect.

A couple of readers e-mailed me with the names of a few customers of Unibased Systems Architecture. To clarify: I wasn’t doubting that they have customers, but I am saying that I don’t know who those customers are, have never heard USA mentioned in a CIO’s presentation, and haven’t gotten any e-mails requesting or offering information about them. Their site lists three new customers the past year. I talked to them once years again, but we bought from a competitor.

Speaking of USA, they get a mention in the St. Louis newspaper, which unfortunately managed to misspell the company’s name in its headline. It is a weird and unwieldy name, I’ll admit.

Some NHS trusts want to break ranks from Cerner Millennium for mental health applications.

McKesson announces Horizon Homecare Wound Advisor. Says its integrated. Could be since it’s home care, but when you see Horizon, always ask: Were all modules developed internally by the same company? Are the development offices in different cities? Is more than one database required? Can the integrated suite run without an interface engine or HL7 processor? Can the entire app be upgraded in one step and by one team? How many ADT feeds are required? Does every client run all the pieces, and if not, how are they disconnected from the mix? Are multiple copies of any table stored? Does any system in the package have different data rules, i.e. dumbing down configuration data so the most backward system in the chain can understand it? Are user tables maintained in just place? Well, I could go on, but you get the picture.

Eclipsys is having its user group meeting starting Sunday (October 7) in Orlando.

Listening: The Clash, London Calling.

Interesting comment from J.D. Kleinke of Omnimedix, the company that was originally developing the Dossia PHR application for big employers, among them Wal-Mart and Intel. “We don’t believe a system that is developed and operated by employers will be trusted by employees.” Based on that, I’d bet that privacy issues were somehow involved in the parting of ways and eventual lawsuits between Dossia and Omnimedix. Maybe the employer-led Dossia wanted keys to the PHR’s back door?

Tennessee vendor Aionex gets some angel investor money. The company is 12 years old, the product seven, and it’s still trying to get going. Advice: lay off the techie buzzwords unless you think programmers are making purchasing decisions. Example from the first paragraph of the home page: “The APRP core is a relational database and data repository for monitoring and modeling process results.” OK, I give up: what are you selling and why should I care?

You know who Philips should buy? Varian Medical Systems. Just a thought.

I forgot to gloat about the Healthvision acquisition scoop: a reader tipped me off long before the official announcement, meaning you read it here on September 14 instead of October 3.
VA had some VistA disruptions in August, ranging from 15 minutes to nine hours. Interesting, but hardly headline-worthy. I’ve never worked in a hospital that didn’t occasionally have outages like that. There are so many points of failure, especially in a regional deployment, and so little money for redundancy that I’d be surprised at five-nines application availability anywhere other than in the data center. Notice I didn’t pile on Kaiser during their HealthConnect downtime problems last year, which I found unremarkable for an IT environment of their size and scope.

Perot Systems loses its Triad Hospitals IT contracts following that hospital group’s acquisition by Community Health Systems.

Shares in athenahealth keep going up: $39.39 at Friday’s close, up $3.09. Tim Draper, inventor of viral marketing by e-mail, has $156 million worth. That’s not how he made his bundle, though: he was an investor in Hotmail and a bunch of other tech companies, also including Skype, for which eBay paid way too much.

E-mail me.

Inga’s Update

Thank you, XLT is Groovy, for enlightening me on Epic’s document manager status. “Epic doesn’t have a DM solution that works at large customer sites. Almost all of their customers go with one of the big DM vendors & interface the pointers to the documents into the system. It works well. Epic does have “EpicScan,” which can be used for low-volume scanning needs.  But most customers don’t use it – it moves too slowly to meet their needs.” So it does bring up more questions in my mind (would customers prefer a fully integrated offering?) but I won’t go there.

The endless iSOFT saga appears to be ending. Shareholders approve the $411 million takeover bid from IBA Health. The final merger is scheduled for completion October 30th.

I have enjoyed reading all the news and commentary about HealthVault. Obviously quite a few people are like Mr. H and see it as just a bunch of hoopla. But I am a bit of a Pollyanna and I like a few aspects. For example:

• Until Thursday of this week, I bet millions of folks never gave any thought to maintaining their own personal health record electronically. If nothing else, Microsoft was stirred the PHR pot a bit and raised awareness – for good or bad. (That being said, my 70’s+ parents have not called to tell me they are ready to use a PHR, though a friend with a special needs child was pretty excited about the concept.)
• I love the device integration aspect. Makes me want to go out and buy a heart monitor just to see how it all works. (And I am sure Bill Gates and friends were betting there were a lot of folks like me.) I could see using HealthVault for this feature alone.
• It’s free. Well, at least to consumers. And likely to healthcare providers. I think EMR companies would have a hard time charging for a HealthVault “interface.” Instead they may be driven to make products “HealthVault-ready.” Personally I like that aspect, too.

Ok, so I see it may all be a pipe dream and never catch on and there are still a lot of missing links. And I have no idea if HealthVault is the best product (will Google’s be better?) or if one day all consumers will want to want to keep their own PHR (perhaps in the next generation). But, I must thank Microsoft for the announcement because now I have a HIT topic I can discuss with strange men in bars over cocktails.

HHS awards $22.5 million in contracts to nine HIEs participating in trial implementations of the Nationwide Health Information Network. I look forward to reading more about how my tax dollars are being allocated when Mike Leavitt posts commentary on his blog.

Inga Chats with Ed Marx About Soarian

Over the past few months, some less than favorable commentary has been posted about the Siemens Soarian application. A couple of “in the know” Soarian users suggested we talk with CIO Edward Marx of the University Hospital Systems in Cleveland, since UH system runs the Soarian revenue cycle products. Ed was happy to share his thoughts with HIStalk, in part because he “wanted to set the record straight” about what was going on at his facility. Ed has headed off to Texas Health Resources in the DFW area to take over as CIO. We thank Ed for making time between packing to discuss the Soarian project at his outgoing 2,000 bed, seven hospital system (and wish him luck!)

Inga: Can you provide with some background on your relationship with Siemens?

Ed: We have been a partner of Siemens for 20+ years and running classic applications like Invision. We decided that we were ready to install a new revenue cycle application for everyone, hospitals and physicians. We selected Soarian after our selection process in 2002 and we have been in the process of implementing over the last two years. We have two out of seven sites up, and will add five more over the next year and a half. We had purchased hospitals with legacy systems, so we ended up replacing QuadraMed, Invision, and a homegrown system, all for Soarian.

During the selection process, who else did you look at?

We were using IDX on the physicians’ side, so we looked at IDX at the time. I wasn’t actually involved at the time, but Soarian and IDX were the finalists.

Why was Soarian selected?

The fact that it offered a single database, a single application could handle both the physician and acute components, rather than require a lot of interfaces. We wanted a single MPI and single database. No one else could, and maybe still cannot today, make the same claim. One of the key drivers was the architecture. At the time they were the only vendor building a system from the ground up rather than re-packaging older systems.

Has it lived up to expectations?

We have had a long-term relationship with Siemens. We knew that going into a new product wouldn’t be smooth and we went with eyes wide open, and we knew that going in that it would take more time. We knew if we had purchased a more mature product it might take less time. There is no doubt about it has taken longer, but we are getting the product we wanted. Being able to work directly with the vendor in a partnership in the design is worth some of the pain.

Overall, what is the satisfaction level of the users in your organization?

Overall we haven’t done a survey of them, but they are pleased. In some cases, it is replacing paper records – hand-written appointments – and in some replacing mainframes. As with any radical change in applications, there are change management issues. People are use to doing things a certain way and change causes anxiety. They are a couple of people in the organization that are adamantly against changes and they are the ones that are probably posting to HIStalk. What happened when we implemented Oracle eBusiness Suite was similar – we also had big change management issues. It took six months to a year – maybe two years – to understand the value of it. Now people don’t know how they ever did what they did before Oracle. I think it will be the same thing with Soarian and with EHR, when we get there.

Which modules would you say are fully developed versus those that still need work?

You probably need to talk with Liz Novak, the VP directly leading this and has more direct knowledge. But, the scheduling module had some logic issues that have since been corrected. Issues that were causing slow-downs. As we find them through testing or during go-live, they are very responsive to make the corrections.

I assume you communicate with other Soarian users. Are there other happy users?

We have extensive communication with other sites. Most of them wish that implementation went faster. The pipeline that is coming down with Siemens is huge. And that is not just marketing rhetoric – I’ve seen plenty of things to suggest it is accurate. There are other users similar to us that are working through implementations and going live. Everyone wishes it could be three years faster, but that is the nature of products of new products.

What are some of the most exciting recent product announcements?

The thing that brings us the most comfort is that there are more institutions going live and their pipeline is quite large. The more customers using the product, the better the product becomes. It seems the product is finally rolling. There is a certain build up before you get the inertia of an initiative. They have now hit the tipping point, so the future looks very bright. We have been live on two sites for a year and are very pleased with the progress.

What have you heard is on the development agenda?

I struggle to give you specifics, but they do have regular releases that we have helped develop and test. New releases are coming every six months, but I can’t articulate well what they are. They have a published schedule and they are starting to hit their dates. With each release, there are that much more feature/functions.

Everyone agrees that the workflow engine is unsurpassed in healthcare, but that doesn’t seem to result in sales. Do you think users undervalue that aspect of the software or are users not really committed to redesigning processes to be workflow-driven?

I think they have made more sales than people think. I have been privy to this list. My concern was that have they tested enough in terms of volume. We are fairly large, so we pressed them pretty hard to be sure they could handle our volume. I have seen up close and personal their testing processes and was privy to a lot of detail in terms of volume and it is impressive. I think they have hit their tipping point and you will see them more and more of them as they hit the implementations.

What Soarian direction is provided from the Malvern office vs. the Siemens AG executives in Germany? How strategic is Soarian in a big company like Siemens?

Good question. I may not be the best one to answer the question, but from what I can tell, there were a lot of best practices and processes brought over from Europe in terms of design and development and discipline. I think it has now kind of shifted back to Malvern in terms of specific directions.

You said you are implementing Eclipsys for clinical. Why not Soarian?

We looked at Siemens. We looked through a robust process at a number of vendors. We tried to determine, “Is there an integrated solution out there today that is rich enough to displace our Soarian as revenue cycle and rich enough to replace Eclipsys?” I am really into integrated solutions as are some other executives. We looked at Epic and IDX, and after a thorough analysis with heavy reliance on our customer base, we didn’t think Siemens was strong enough on clinicals to replace Eclipsys and Eclipsys wasn’t strong enough on the revenue cycle, so we went with the best-of-breed approach. Vendors are getting closer to it, but a year and half ago, we didn’t think anyone could do it real well.

With Eclipsys, our first live will be on the ED Tracking module in December. Our hospitals go up with orders in late 2008. It is going very well, but the project is young. It is a four-year process and we are still in year one.

Anything additional you want to add?

Well, you are getting this from me. A lot of people have written in that Soarian is not ready, there is no one live. That is myth that needed to be dispelled. The other thing is, they do have a very active pipeline and we share development notes. The volume is pretty impressive from new customers. It is true that not everyone is satisfied, but no one ever is carte blanche. There are always change management issues, but at the end of the day, you have to work with your customers and ensure you are doing the right thing and the majority will come to find the benefits of the new applications. But, you won’t ever satisfy everyone.

E-mail Inga.